Bleeding gastroduodenal ulcer with a high risk of recurrence. Treatment tactics

Acute bleeding ulcer is still the main cause of hospitalization. This review presents a structured approach to the modern treatment of ulcerative bleeding and highlights the strategy in situations where there is a high risk. The initial methods of treatment – pharmacotherapy and endoscopy, as well as risk stratification, surgery and X-ray endovascular embolization are considered, and their role in the treatment of ulcerative bleeding with a high risk is critically discussed. The perspective regarding preventive X-ray endovascular embolization is highlighted. In addition to the achievements of pharmacotherapy and endoscopy, the treatment of bleeding with a high risk remains a difficult task. When endoscopy is ineffective and the bleeding does not stop or recurs, surgical and radiological methods are indicated for its relief. Surgical treatment is effective, but it is still associated with higher disability, prolonged hospital stays and mortality. Arterial embolization is recommended as an alternative to surgical intervention and more often replaces surgical in patients with severe comorbid background. Patients with this problem often belong to the elderly age group, which is associated with a severe comorbid background, and, therefore, a multidisciplinary approach to treatment is required. The treatment algorithm needs clear risk criteria and a structured treatment approach due to higher morbidity and mortality compared to conventional ulcerative bleeding. In addition, a promising approach of preventive embolization in peptic ulcer disease with a high risk requires further study.