Perforated and bleeding peptic ulcer: WSES guidelines
WSES · 2020 · international
Source and licence
- Authors
- Antonio Tarasconi, Federico Coccolini, Walter L. Biffl et al.
- Title
- Perforated and bleeding peptic ulcer: WSES guidelines
- Journal
- World Journal of Emergency Surgery : WJES, 2020
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC6947898
Licence statement of the original publication
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Resuscitation
- We recommend a rapid and careful surgical/medical evaluation of bleeding peptic ulcer disease patients to prevent further bleeding and to reduce mortalitystrong recommendation based on very low-quality evidences, 1D
- We recommend evaluating several elements (symptoms, signs, and laboratory findings) to assess the stability/instability of patients with bleeding peptic ulcer at ED referralstrong recommendation based on low quality evidences, 1C
- We recommend several resuscitation targets, similar to those of damage control resuscitation in the bleeding trauma patientweak recommendation based on low-quality evidences, 1C
Non-operative management—endoscopic treatment
- We suggest stratifying patients based on the Blatchford score and adopting a risk-stratified management (weak recommendation based on very low-quality evidences, 2D): • In the very low-risk group, we suggest outpatient endoscopy (weak recommendation based on low-quality evidences, 2C) • In the low-risk group, we recommend early inpatient endoscopy (≤ 24 h of admission) (strong recommendation based on low-quality evidences, 1C). • In the high-risk group, we recommend urgent inpatient endoscopy (≤ 12 h of admission)strong recommendation based on low-quality evidences, 1C
Angiography, embolization
- We suggest against a routinely use of angioembolization unstable patients. Angioembolization in unstable patients could be s considered only in selected cases and in selected facilitiesweak recommendation based on very low-quality evidences, 2D
Surgery
- We suggest choosing the surgical procedure according to the location and extension of the ulcer and the characteristics of the bleeding vesselweak recommendation based on low-quality evidences, 2C
- We suggest considering damage control surgery for patients with hemorrhagic shock and signs of severe physiological derangement, in order to quickly resolve the bleeding and allow a prompt ICU admissionweak recommendation based on very low-quality evidences, 2D
Antimicrobial therapy
- We recommend performing Helicobacter pylori testing in all patients with bleeding peptic ulcerstrong recommendation based on low-quality evidences, 1C
- We recommend to start standard triple therapy (STT) after 72–96 h of intravenous administration of PPI and to administer it for 14 daysstrong recommendation based on low-quality evidences, 1C
Abstract
Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5–10% and an incidence of 0.1–0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10–20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment.
Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached.
Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
Contents of the original publication
The section headings of the original.
- Introduction
- Notes on the use of the guidelines: aims, targets, and limitations
- Methods
- Topics and questions
- Perforated peptic ulcer
- Diagnosis
- Resuscitation
- Non-operative management—endoscopic treatment
- Surgery
- Antimicrobial therapy
- Bleeding peptic ulcer
- Diagnosis
- Resuscitation
- Non-operative management—endoscopic treatment
- Angiography, embolization
- Surgery
- Antimicrobial therapy
- Conclusions
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