Upper Gastrointestinal Bleeding Due to a Peptic Ulcer

Peptic ulcers, often due to Helicobacter pylori or the use of nonsteroidal antiinflammatory drugs (NSAIDs), commonly cause upper gastrointestinal bleeding. Endoscopic therapy, proton-pump inhibitors, therapy for H. pylori infection, and nonuse of NSAIDs are described. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage A 55-year-old woman presents to the emergency department at 11:30 p.m. with hematemesis. She is otherwise healthy and has no risk factors for liver disease. Her only medication is aspirin (at a dose of 81 mg daily), which she started to take 6 months ago after reading that it reduces the risk of heart disease. The blood pressure is 94/60 mm Hg, and the heart rate is 108 beats per minute; the physical examination is otherwise normal. The hemoglobin level is 11.0 g per deciliter, platelet count 220,000 per cubic millimeter, international normalized ratio 1.0, and blood urea nitrogen . . .