Peptic Ulcer Bleeding: Update on Standards from International Guidelines

We review the latest advances in management of peptic ulcer bleeding and the updates from international guidelines. A low Glasgow Blatchford score of ≤ 1 can safely identify low-risk patients to manage in out-patient settings. Except patients with persistent haemodynamic instability, early endoscopy within 24 h appears safe when compared with earlier intervention. Over-the-scope-clips (OTSC) show promising result as first-line and second-line endoscopic haemostaic therapy, while haemostatic spray can be considered as a stop-gap treatment. After endoscopic intervention, high-dose oral proton-pump-inhibitor (PPI) is an alternative to intravenous use in selected cases. Retrospective data shows new-generation P2Y12 inhibitors (prasugrel and ticagrelor) have higher risk of bleeding when compared with clopidogrel. Vonoprazan, a potassium-competitive acid blocker and a potent acid suppressor, shows encouraging initial results in management of gastrointestinal bleeding. Endoscopic therapy remains the mainstay of treatment of peptic ulcer bleeding and future research will clarify the role of new endoscopic treatment modalities such as OTSC. Good peri-endoscopic treatment remains crucial, and more data is needed to guide management in patients on new generation anti-platelet drugs and direct oral anti-coagulants.