Non-variceal upper gastrointestinal bleeding: future prospects

Pharmacotherapy involving the vasoactive drug somatostatin is widely used in the treatment of bleeding oesophageal varices. However, somatostatin may also have a role in the management of non-variceal upper gastrointestinal (UGI) bleeding. Non-variceal UGI bleeding can result from a number of conditions, including peptic ulcers, gastric erosions and portal hypertensive gastropathy. The most common cause of UGI bleeding is peptic ulcers, of which there are two forms - those secondary to the use of non-steroidal anti-inflammatory drugs and those resulting from colonisation of the stomach by Helicobacter pylori. Although bleeding ceases spontaneously in similar to 80% of patients with non-variceal UGI bleeding, the remaining, high-risk patients require active treatment. A number of controlled clinical trials have demonstrated that somatostatin was more effective at controlling bleeding than either H-2-receptor antagonists or placebo in the high-risk patients. These observations suggest that somatostatin is a valuable treatment for high-risk patients admitted with severe peptic ulcer haemorrhage. The control of bleeding by somatostatin improves the visibility at diagnostic endoscopy and enables endotherapy to be performed more easily. In addition, it has an excellent safety profile and therefore does not further complicate the clinical management of these patients.