Peptic Ulcers - Treatment for Bleeding Ulcers

Highlights	Risk Factors	Treatment for Bleeding Ulcers
Introduction	Diagnosis	Lifestyle Changes
Causes	Treatment	Resources
Symptoms	Treatment for NSAID-Induced Ulcers	References
Complications	Medications

Treatment for Bleeding Ulcers

When a patient comes to the hospital with bleeding ulcers, in most cases, endoscopy is performed. This procedure is critical for all phases of bleeding ulcers, including diagnosis, determination of treatment options, and treatment itself.

In high-risk patients or those with evidence of bleeding, options include watchful waiting with medical treatments or surgery. The first critical steps for massive bleeding is to stabilize the patient and support vital functions with fluid replacement and possibly blood transfusions. People on NSAIDs should discontinue them if possible.

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Depending on the intensity of the bleeding, patients can be released from the hospital within a day or kept up to three days after endoscopy. Bleeding stops spontaneously in about 70% to 80% of people, but 30% of patients who come to the hospital for bleeding ulcers will need surgery. Endoscopy is the surgical procedure most often used for treating bleeding ulcers and for patients at high-risk for rebleeding. It is usually used in combination with medications, such as epinephrine and intravenous proton-pump inhibitors.

Between 10% to 20% of patients require more invasive procedures, usually major abdominal surgery. Such patients are usually bleeding.

Endoscopy for Treating or Preventing Bleeding Ulcers

Endoscopy is important for both diagnosing and treating bleeding ulcers. The doctor first places an endoscope (a thin, flexible plastic tube) into the patient's mouth and down the esophagus (food pipe) into the stomach.

Endoscopy Used for Diagnosing Bleeding Ulcers and Determining Risk for Rebleeding. Doctors are able to detect the signs of bleeding such as active spurting or oozing of blood from arteries. Endoscopy can also detect specific features in the ulcers referred to as stigmata, which indicate a higher or lower risk for rebleeding.

Such features include the following:

Low-risk (5% to 15%) for bleeding: flat dot; a clean or white base.
High-risk (30% to 50%) for bleeding. Swollen but nonbleeding blood vessels; blood clots that adhere to ulcers.
According to one study, if patients with these high-risk features are untreated, their risk for rebleeding after endoscopy ranges from about 10% in the first day after endoscopy to about 3% by the third day. Identifying and treating patients with high-risk features in the ulcers (referred to as stigmata) can reduce these risks. (Other factors that increase the risk for rebleeding include have bleeding disorders, very low blood pressure, other serious medical conditions, and bleeding that started after hospitalization.)