Peptic Ulcers - Treatment for Bleeding Ulcers

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Other Medical Considerations. Certain agents may be warranted after endoscopy:

• Patients who harbor the H. pylori bacteria, even if NSAIDs caused the bleeding, should be treated with antibiotic therapy to eradicate the bacteria. Triple therapy, including antibiotics, to eradicate H. pylori immediately after endoscopy is warranted in most patients infected with the bacteria.
• Somatostatin (a hormone used to prevent bleeding in cirrhosis) is also useful for reducing persistent peptic ulcer bleeding or the risk of recurrence. Researchers are investigating adding other therapies, such as fibrin glue, a blood clotting factor. To date, no therapy has proven to be more effective than the current treatments.

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Major Abdominal Surgery

Major abdominal surgery for bleeding ulcers is now generally performed only when endoscopy fails or is not appropriate. Certain emergencies may require surgical repair, such as when an ulcer perforates the wall of the stomach or intestine, causing sudden intense pain and life-threatening infection.

Surgical Approaches. The standard major surgical approach uses a wide abdominal incision and standard surgical instruments (called open surgery). Laparoscopic techniques employ small abdominal incisions and the insertion of tubes that contain miniature viewing tubes and instrument. Laparoscopic techniques are increasingly being used for perforated ulcers. Surgery is not effective for upper GI ulceration caused by chronic NSAID use.

Major Surgical Procedures. There are a number of surgical procedures aimed at long-term relief of ulcer complications.

Click the icon to see an illustrated series detailing a gastrectomy procedure.

• Vagotomy cuts the vagus nerve and interrupts messages from the brain that stimulate acid secretion in the stomach. This surgery may impair stomach emptying; a recent variation that cuts only parts of the nerve may reduce this complication.
• Antrectomy removes the lower part of the stomach, which manufactures the hormone responsible for stimulation of digestive juices.
• Pyloroplasty enlarges the opening into the small intestine so that stomach contents can pass into it more easily.

Antrectomy and pyloroplasty are usually performed with vagotomy.

Review Date: 07/14/2006
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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