Nonvariceal Upper Gastrointestinal Bleeding

Introduction

This topic was elegantly reviewed a year ago by Rollhauser and Fleischer [1]. The conclusions at the time are largely echoed this year, with no major changes in either treatment algorithms or outcomes. The incidence of peptic ulcer bleeding appears to be declining slowly, more so in the duodenum, with a slight rise in the incidence of gastric ulcer. The value of early endoscopy appears to be clear, while second-look endoscopy remains controversial. Intensive-care monitoring appears to be of value, as well as proton-pump inhibitor (PPI) treatment, although protection against stress ulcers is still inadequate.

Endoscopic treatment is still being conducted along familiar lines, but increasing data suggest that a combination of injection therapy and thermal/mechanical therapy may offer the best results. Endoscopic suturing techniques suitable for clinical use are still awaited.

References

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