management of bleeding peptic ulcer

Last reviewed 01/2018

General management is as for other causes of upper gastrointestinal bleed.

Specific points:

• bleeding often stops spontaneously (in 80-90% of cases)

• endoscopic therapy has now become the treatment of choice. Injection sclerotherapy, e.g. with adrenaline, is often used. Other techniques available include heater probe and laser. Endoscopic therapy is indicated if there is evidence of continued or recurrent bleeding, e.g. active bleeding from ulcer, visible vessel in the base of ulcer.

• if bleeding continues, e.g. patient requires more than 4 units after initial volume was restored, then surgical intervention is indicated. This usually involves control of the bleeding site, e.g. by under-running or excision, and a definitive procedure e.g. a partial gastrectomy.