Management of peptic ulcer bleeding—the roles of proton pump inhibitors and Helicobacter pylori eradication

Abstract

SUMMARYPeptic ulcer bleeding is associated with substantial morbidity and mortality. The goals of management are to control any active bleeding and prevent re-bleeding and then to heal the ulcer and prevent its recurrence. Initial management strategies are guided by the patient's clinical condition and endoscopic findings. Thus, treatment may consist of endoscopic and medical therapy and, sometimes, surgery. Control of acid secretion, preferably with proton pump inhibitor therapy in the initial management continues to evolve; it has also been used as both an adjunct to endoscopic therapy and as primary treatment. These agents have been found to be effective in some trials in the reduction of re-bleeding and the need for surgery, although there is no clear benefit demonstrated for overall mortality. Proton pump inhibitors have been administered either intravenously or orally in different trials. The long-term management of patients with peptic ulcer, after the initial bleeding episode, should include patient stratification based upon risk factors for ulcer recurrence (i.e. Helicobacter pylori infection, use of aspirin or nonsteroidal anti-inflammatory drugs). Elimination or modification of these risk factors reduces the risk of ulcer recurrence and, hence, of recurrent ulcer bleeding.

Recombinant Human Epidermal Growth Factor Alleviates Gastric Antral Ulcer Induced by Naproxen: A Non-steroidal Anti Inflammatory Drug

“…Ulcer is a debilitating disease affecting a significant proportion of the population globally [1]. Epidemiological studies show that males have about three times as many ulcers as females between the ages of fifty-five and seventy years.…”

Latin American Consensus on Gastroesophageal Reflux Disease: An Update on Therapy

“…Overview: There are data to indicate that H. pylori infection is associated with changes in gastric acidity and acid secretion, that H. pylori-infected individuals with GERD may have more rapid healing and lower relapse rates for erosive esophagitis 68 and that H. pylori eradication is associated with decreased PPI efficacy in reducing gastric acidity. However, there is also good evidence (type 1) that H. pylori infection has no effect on GERD and that its eradication does not worsen GERD symptoms.…”

Endoscopic Therapy for Peptic Ulcer Bleeding

“…The use of PPI also decreases the sensitivity of the CLO test, breath test and stool antigen test [54]. It is unknown how many days of PPI treatment are needed before the tests become less accurate [55]. Histology examining for chronic active gastritis is a reliable marker H. pylori infection which is not influenced by PPI therapy.…”