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Endoscopy 2000; 32(12): 935-942
DOI: 10.1055/s-2000-9627
Original Article
© Georg Thieme Verlag Stuttgart · New York

Management in Peptic Ulcer Hemorrhage:A Dutch National Inquiry

M.  E.  van Leerdam1 , , E.  A.  J.  Rauws1 , , A.  A.  M.  Geraedts2 , , G.  N.  J.  Tytgat1
  • 1 Dept. of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
  • 2 Dept. of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Publication History

Publication Date:
31 December 2000 (online)

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Background and Study Aims: There is no consensus as to what endoscopic hemostatic therapy and pharmacotherapy should be used in peptic ulcer hemorrhage (PUH). We conducted a mail survey to investigate current management of ulcer hemorrhage in the Netherlands.

Methods: A questionnaire was sent to gastroenterologists or, if not present, to internists, performing endoscopies, in every hospital in the Netherlands (n = 123). Endoscopic hemostatic therapy, pharmacotherapy, endoscopic reintervention, and management of Helicobacter pylori were evaluated.

Results: 90/123 (73 %) questionnaires were returned. Endoscopic hemostatic therapy is given in ulcers classified as Forrest Ia, Ib, IIa, IIb, and IIc by, respectively, 89 %, 93 %, 83 %, 47 %, and 19 % of respondents. Gastroenterologists perform endoscopic therapy more often in Forrest Ib (P = 0.03), IIa (P = 0.002), and IIb (P = 0.001) ulcers when compared with internists. Endoscopic injection therapy is used by 93 % of respondents as first modality. Epinephrine combined with polidocanol is most commonly used (60 %). Pharmacotherapy is given by 97 %. A total of 71 % use proton pump inhibitors (PPIs), and 26 % use H2-receptor antagonists (H2RAs), both mainly initially given intravenously. In case of suspected rebleeding, endoscopic reintervention is performed by 76 %, including a significantly greater percentage of gastroenterologists (89 % of gastroenterologists vs. 60 % of internists, P = 0.005), whereas the others refer the patient directly for surgery. Almost all respondents investigate for H. pylori. Eradication is confirmed by only 64 % (80 % of gastroenterologists vs. 50 % of internists, P = 0.004).

Conclusions: There are important differences in management of peptic ulcer hemorrhage between gastroenterologists and internists in the Netherlands. Management is only partly in accordance with evidence-based medicine.

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M. E. van Leerdam,M.D. 

Dept. of Gastroenterology


Academic Medical Center

Meibergdreef 9 1105 AZ

Amsterdam The Netherlands

Fax: Fax:+ 31-20-6917033

Email: E-mail:m. e.vanleerdam@amc.uva.nl