Acute bleeding from peptic ulcers. How to restore hemostasis and prevent recurrence.

Prompt resuscitation is the cornerstone in management of acute upper gastrointestinal bleeding. Endoscopy has become the diagnostic procedure of choice because it offers the chance for hemostatic therapy. For patients in whom endoscopy reveals actively bleeding peptic ulcers or nonbleeding peptic ulcers or nonbleeding ulcers with visible vessels, endoscopic therapy decreases the likelihood that the patient will bleed further, require surgery, or die. Patients with critical illnesses requiring intensive care should receive prophylaxis against stress ulcers. Long-term management of bleeding peptic ulcer disease includes educating patients to quit smoking, avoid non-steroidal anti-inflammatory drugs, and comply with maintenance therapy with a histamine2 receptor antagonist.