Insights in Blood Pressure

Upper gastrointestinal bleeding is the most common and potentially life threatening emergency. Despite great advances in the field of medicine, the optimal management of bleeding peptic ulcer with adherent clot on endoscopy is still controversial. The aim of this study is to compare the combined endoscopic and medical therapy with medical therapy alone for bleeding peptic ulcer with adherent clot (Forrest type IIB). During two-year study period, around 342 patients presented to our Tertiary care hospital with acute upper gastrointestinal bleeding. Out of these, 81 patients were noted to have adherent clot (Forrest type IIB) during endoscopy and were included in study. 40 patients received combined endoscopic and medical treatment, whereas 41 patients received medical treatment only. The base line characteristics of patients in two groups were comparable and statistically significant. Primary Outcome being recurrence of bleeding within 7 days of treatment was less in combined therapy group compared to medical therapy group (2.5% vs. 17.1%) This was statistically significant. Secondary outcome like recurrence of bleed in 30 days and need for repeat endoscopy were less in combined group compared to medical therapy group. These were statistically significant as well. Other secondary outcomes like necessity for surgery and mortality were fewer in combined group, but these were not statistically significant. In conclusion combination endoscopic therapy consisting of epinephrine injection, removal of the adherent clot, and treatment of underlying stigmata is more effective than medical therapy alone.

Introduction Upper gastrointestinal bleeding (UGIB) is common and potentially life-threatening

gastrointestinal emergency. Нe annual incidence of hospitalization for acute UGIB is 1 per 1000 people in Americawith a mortality rate of 7% to 10% Upper gastrointestinal Endoscopy (EGD) is the prime diagnostic and therapeutic tool for UGIB It precisely delineates the bleeding site and determines the specLfic cause. EGD is 90% to 95% diagnostic for acute UGIB [4]. Patients aіer initial resuscitation should undergo early endoscopy (within 24 hours). It helps to identify stigmata of recent hemorrhage (SRH), in patients with underlying peptic ulcer disease. Patient with high risk SRH like active bleed or visible vessel needs endoscopic intervention to reduce morbidity and mortality ]

with a clean base or with a flat pigmented spot have a low risk of rebleeding and do not require endoscopic- therapy . Ulcers with adherent clot carry 8 to 36 percent risk of rebleeding optimal management of ulcers with adherent clot is controversial. Endoscopic therapies include injection, ablation, and mechanical therapy. Нe above three endoscopic therapies are eٔوectLve as monotherapies, but combined therapies increase the eÙ¹cacy Proton pump inhibitor (PPI) therapy is recommended for patients with acute UGIB. НLs therapy reduces the severity of SRH at endoscopy and reduces the need for endoscopic therapy as compared with no treatment or histamine-2 antagonist (H2 Blocker) therapy . PPI therapy modestly reduces the risk for rebleeding, need for surgery, and blood transfusions, however so far hasn’t shown to reduce mortality .Нe benefit is greatest in patients who have high risk SRH, such as a visible vessel. Although intravenous infusion is ideal, oral PPI therapy provides much of the benefit .Нe rationale for PPI therapy is that most common causes of UGIB, including ulcers, gastritis, duodenitis and hemorrhagic reflux