Management of bleeding peptic ulcer disease

Bleeding from peptic ulcers can have severe consequences. Most patients are managed with fluid resuscitation and when necessary hemostasis can be achieved via an endoscopic approach. While rebleeding after a successful endoscopic procedure is rare it may require a repeat endoscopy. Patients who do not respond to this initial approach may benefit from direct surgical control of the bleeding with oversewing of the ulcer with or without additional acid-suppressing procedures such as the vagotomy and antral resection. Patients who are deemed too high risk for surgery may benefit from angiographic embolization of the bleeding ulcer that has continued to bleed or has failed other measures.