The long‐term management of patients with bleeding duodenal ulcers

Abstract

Background: Gastrointestinal haemorrhage is a common complication of duodenal ulcers. Patients who bleed are at substantial risk of recurrent bleeding. Aim: To determine whether appropriate therapeutic steps were taken to reduce the risk of recurrent haemorrhage in patients with a bleeding duodenal ulcer. Methods: The management of patients surviving a duodenal ulcer bleed in the University Hospital, Nottingham, was assessed by case‐note review before (1993) and after (1995–1996) institution of clinical guidelines. The following measures aimed at reducing the risk of recurrent haemorrhage were considered appropriate: stopping non‐steroidal anti‐inflammatory drugs (NSAIDs) when these were implicated in bleeding; successful eradication of Helicobacter pylori if present; and long‐term maintenance acid‐suppression therapy. Results: In 1993, appropriate steps were taken to reduce the risk of recurrent haemorrhage in only 48% of cases. Following the institution of guidelines, management improved significantly in 1995–1996 (appropriate in 83% of cases, P<0.001), was associated with increased referral to gastroenterologists (P<0.001), improved patient compliance with follow‐up (P<0.05), and more rigorous attempts to identify (P<0.001) and ensure clearance (P<0.001) of H.␣pylori. Conclusion: In this study, inadequate long‐term management of patients with a bleeding duodenal ulcer was common. This was due to a failure to adopt strategies aimed at reducing the risk of ulcer relapse and rebleeding. The quality of care improved significantly following the institution of guidelines and encouragement to refer to gastroenterologists.

Management ofHelicobacter pyloriinfection—the Maastricht IV/ Florence Consensus Report

“…However, it has been shown that H pylori infection/eradication has no effect on early rebleeding rate in patients with peptic ulcer bleeding after endoscopic haemostasis 161 162. On the other hand, delaying treatment to after discharge leads to reduced compliance or loss to follow-up without receiving treatment 163. Based on a decision analytic model, it has been recently proposed that empirical treatment of H pylori infection in patients with bleeding peptic ulcer, immediately after feeding is restarted, is the most cost-effective strategy for preventing recurrent haemorrhage 164.…”

What Is the Best Strategy for Diagnosis and Treatment of Helicobacter pylori in the Prevention of Recurrent Peptic Ulcer Bleeding? A Cost-Effectiveness Analysis

“…Second, the sensitivity of diagnostic techniques for H. pylori infection falls markedly during bleeding [5]. Finally, histology findings are often unavailable at discharge and, in clinical practice studies, more than 50% of bleeding patients were lost to follow‐up without receiving treatment [6].…”