Challenges in the management of acute peptic ulcer bleeding

Lancet. 2013 Jun 8;381(9882):2033-43. doi: 10.1016/S0140-6736(13)60596-6.


Acute upper gastrointestinal bleeding is a common medical emergency worldwide, a major cause of which are bleeding peptic ulcers. Endoscopic treatment and acid suppression with proton-pump inhibitors are cornerstones in the management of the disease, and both treatments have been shown to reduce mortality. The role of emergency surgery continues to diminish. In specialised centres, radiological intervention is increasingly used in patients with severe and recurrent bleeding who do not respond to endoscopic treatment. Despite these advances, mortality from the disorder has remained at around 10%. The disease often occurs in elderly patients with frequent comorbidities who use antiplatelet agents, non-steroidal anti-inflammatory drugs, and anticoagulants. The management of such patients, especially those at high cardiothrombotic risk who are on anticoagulants, is a challenge for clinicians. We summarise the published scientific literature about the management of patients with bleeding peptic ulcers, identify directions for future clinical research, and suggest how mortality can be reduced.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Antifibrinolytic Agents / therapeutic use
  • Blood Coagulation Disorders / complications
  • Blood Component Transfusion / statistics & numerical data
  • Contraindications
  • Decision Making
  • Endoscopy, Gastrointestinal / statistics & numerical data
  • Fibrinolytic Agents
  • Gastrointestinal Agents / therapeutic use
  • Humans
  • Peptic Ulcer Hemorrhage / diagnosis
  • Peptic Ulcer Hemorrhage / mortality
  • Peptic Ulcer Hemorrhage / prevention & control*
  • Proton Pump Inhibitors / therapeutic use
  • Resuscitation / methods
  • Resuscitation / statistics & numerical data
  • Risk Assessment / methods
  • Secondary Prevention
  • Treatment Outcome


  • Antifibrinolytic Agents
  • Fibrinolytic Agents
  • Gastrointestinal Agents
  • Proton Pump Inhibitors