[Treatment of upper gastrointestinal bleeding caused by peptic ulcer]. 2002

Pál Ondrejka
Altalános Orvostudományi Kar, II. Sebészeti Klinika, Semmelweis Egyetem, Budapest. onpal@kut.sote.hu

BACKGROUND The diagnosis and treatment of gastrointestinal bleeding represent a major problem even today. Nearly 50% of upper gastrointestinal bleedings are originating from peptic ulcers of different locations. Thanking to the modern gastroenterological treatment the number of elective operations carried out because of peptic ulcers is very low. On the other hand the number of urgent operations required by the complications--mainly by bleeding--of the ulcers is still rather high. OBJECTIVE Summarizing the possible treatments of these patients. RESULTS The therapeutic endoscopy accompanied by the medical treatment has the primary role in the treatment of bleeding peptic ulcers. If this treatment fails, the surgical treatment is mandatory. Also surgical treatment is necessary in case of massive rebleeding. These kinds of operations are accompanied by a high morbidity and mortality, so it is understandable that the surgeons are trying to avoid them. After spontaneous or successful endoscopic cessation of bleeding in some cases rebleeding can be expected. The probability of rebleeding can be predicted with the consideration of predictive factors. With the help of such prognosis we can decide the indication of "early elective operation". In the surgical treatment we can expect better results with more "aggressive" type of operations (resections). The delay of an indicated operation, or repeatedly carried out endoscopic and medical treatment can reduce the survival chance of the bleeding patients. CONCLUSIONS The treatment of upper gastrointestinal bleeding is a multidisciplinary task, which needs the correct cooperation of gastroenterologists, intensive therapists and surgeons.

UI MeSH Term Description Entries
D010438 Peptic Ulcer Hemorrhage Bleeding from a PEPTIC ULCER that can be located in any segment of the GASTROINTESTINAL TRACT. Hemorrhage, Peptic Ulcer,Peptic Ulcer Hemorrhages,Ulcer Hemorrhage, Peptic
D011237 Predictive Value of Tests In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test. Negative Predictive Value,Positive Predictive Value,Predictive Value Of Test,Predictive Values Of Tests,Negative Predictive Values,Positive Predictive Values,Predictive Value, Negative,Predictive Value, Positive
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D004724 Endoscopy Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body. Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D012720 Severity of Illness Index Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder. Illness Index Severities,Illness Index Severity
D015994 Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases in the population at a given time. Attack Rate,Cumulative Incidence,Incidence Proportion,Incidence Rate,Person-time Rate,Secondary Attack Rate,Attack Rate, Secondary,Attack Rates,Cumulative Incidences,Incidence Proportions,Incidence Rates,Incidence, Cumulative,Incidences,Person time Rate,Person-time Rates,Proportion, Incidence,Rate, Attack,Rate, Incidence,Rate, Person-time,Rate, Secondary Attack,Secondary Attack Rates
D017558 Elective Surgical Procedures Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery. Surgical Procedures, Elective,Elective Surgical Procedure,Procedure, Elective Surgical,Procedures, Elective Surgical,Surgical Procedure, Elective

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