Advances in the Therapy of Bleeding Peptic Ulcer

被引:2
作者
Beales, Ian L. P. [1 ]
机构
[1] Norfolk & Norwich Univ Hosp, Dept Gastroenterol, Norwich NR4 7UY, Norfolk, England
关键词
Gastrointestinal haemorrhage; peptic ulcer haemorrhage; endoscopic hemostasis; H pylori; Hemospray; inorganic powder; anaemia; anticoagulant drugs; non-steroidal anti-inflammatory drugs;
D O I
10.1177/1179559X18790258
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Peptic ulcer bleeding remains an important medical emergency. Important recent advances are reviewed. These include further support for a more restrictive transfusion strategy aiming for a target haemoglobin of 70-90 g/L. The Glasgow-Blatchford score remains the most useful assessment score for identifying the lowest risk patients suitable for outpatient management and predicting the need for intervention. Newer scores such as the AIMS65 and Progetto Nazionale Emorragia Digestive score (PNED) may be more accurate in predicting mortality. Pre-endoscopy erythromycin improves outcomes and is underused. A new disposable Doppler probe appears to provide more accurate determination of both rebleeding risk and the success of endoscopic therapy than purely visual guidance. Over-the-scope clips and haemostatic powders appear to have some role as endoscopic salvage therapies. Non-H. pylori, non-aspirin/non-steroidal anti-inflammatory drug (NSAID) ulcers contribute to an increasing percentage of bleeding peptic ulcers and are associated with a high rebleeding rate. The optimal management of these ulcers remains to be determined.
引用
收藏
页数:15
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