[Hemorrhagic gastroduodenal ulcer: contribution of new medical treatments]. / Ulcéres gastro-duodénaux hémorragiques. Apport des nouvelles thérapeutiques médicales.

ABSTRACT

The mortality due to upper gastrointestinal haemorrhage from ulcers has remained unchanged for several (estimated to be 6%), despite progress in surgery and intensive care, new drug treatments and, more recently, the development of endoscopic treatments. Drug treatments, although frequently used in practice always have a controversial haemostatic efficacy. Antacids have a haemostatic efficacy, but only at doses responsible for side effects. Antisecretory drugs appear to be systematically prescribed, if only to commence treatment of the peptic ulcer disease. However, their haemostatic efficacy has not been established except in the sub-group of gastric ulcers, especially in elderly subjects. According to a recent study, prostaglandins are as active as antacids. Since 1975, endoscopy is the support for haemostatic treatments, most of which are still under evaluation. Therapeutic injections, a simple and inexpensive technique, certainly represents one of the most promising methods. Different authors have proposed different solutions for injection (absolute alcohol, aetoxysclerol, adrenaline, thrombin...) with comparable haemostatic efficacy. Laser photocoagulation (Argon and Nd-YAG) is an expensive and impractical technique and a number of randomised studies indicate that the initial enthusiasm for this technique is not justified. Monopolar electrocoagulation does not constitute a real progress in contrast with bipolar electrocoagulation which significantly decreases the frequency of recurrent haemorrhages. Lastly, the efficacy of the heater probe remains to be evaluated in the light of promising studies, particularly those of Johnson in 1985. At the present time, these endoscopic haemostatic treatment should be reserved to high surgical risk patients (elderly or debilitated subjects).(ABSTRACT TRUNCATED AT 250 WORDS)