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Peptic Ulcer Essay

280 words - 2 pages

Medical Bulletin

VOL.14 NO.11 NOVEMBER 2009

Management of Peptic Ulcer Bleeding
Dr. Carmen Ka-man NG
Associate Consultant, Department of Medicine and Geriatrics, Princess Margaret Hospital

Dr. Carmen Ka-man NG

This article has been selected by the Editorial Board of the Hong Kong Medical Diary for participants in the CME programme of the Medical Council of Hong Kong (MCHK) to complete the ...view middle of the document...

Upper gastrointestinal bleeding (GIB) is defined as haemorrhage proximal to the ligament of Treitz. Peptic ulcer bleeding accounts for 60% of the cases.1 Despite advances in endoscopic treatment and pharmacotherapy, the mortality of upper GIB remains unchanged. In-hospital mortality was found to be 7.1% in 3220 patients admitted for bleeding peptic ulcers from 1993 to 2003 to a teaching hospital in Hong Kong.2 History taking and physical examination help to define the underlying cause. It should be followed by a detailed haemodynamic assessment. Resting tachycardia (pulse 100/min), hypotension (sBP 6 favours platelet aggregation, clot formation and inhibition of fibrinolysis.3 The effect of preemptive PPI before endoscopy was studied. Daneshmend had conducted a randomised study in 1147 unselected patients presenting with upper gastrointestinal bleeding. 578 patients were given omeprazole (bolus 80mg IVI, followed by 40mg IVI for three doses, then 40mg orally every 12 hours) compared to a placebo arm of 569 patients.4 Endoscopic signs of upper GIB in the treatment group (33%) were significantly lower than in the placebo group (45%), p

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