Abstract

Most patients with acute upper gastrointestinal (UGI) haemorrhage bleed from a gastric or duodenal ulcer. About three-quarters stop bleeding before or soon after they reach hospital and do not rebleed during their admission. Most deaths in hospital occur in those who rebleed, in those over 60 or in those undergoing emergency surgery.¹ Postoperative complications are the commonest potentially avoidable cause of death in patients with UGI bleeding.² Any therapy that can prevent early rebleeding from peptic ulcers might therefore reduce operative rates and thus overall mortality rates. Several drugs are claimed to prevent rebleeding from peptic ulcers. This article assesses the evidence on which these claims are founded; it does not consider bleeding from oesophageal varices or acute erosions, or endoscopic haemostasis.