A team from Amsterdam, the Netherlands, conducted a mail survey to investigate current management of peptic ulcer hemorrhage in the Netherlands.
A questionnaire was sent to gastroenterologists or internists in every hospital in the Netherlands (n = 123). Endoscopic hemostatic therapy, pharmacotherapy, endoscopic reintervention, and management of Helicobacter pylori were evaluated.
73 per cent of all questionnaires were returned.
The researchers found that endoscopic injection therapy was used by 93 per cent of respondents as a first intervention. Epinephrine combined with polidocanol was most commonly used (60 per cent).
Medical tratment was given by 97 per cent. Most (71 per cent) used proton pump inhibitors; 26 per centused H2-receptor antagonists. Both were usually given intravenously, initially.
In cases of suspected rebleeding, endoscopic reintervention was performed by 76 per cent, including a significantly greater percentage of gastroenterologists (89 per cent of gastroenterologists vs. 60 per cent of internists), whereas the others referred patients directly for surgery.
H. pylori eradication confirmed by 80 % of gastroenterologists vs. 50 % of internists
Almost all respondents investigated for H. pylori. Eradication was confirmed by only 64 per cent (80 per cent of gastroenterologists vs. 50 per cent of internists).
Researcher M. E. van Leerdam concluded on behalf of the group, "There are important differences in management of peptic ulcer hemorrhage between gastroenterologists and internists in the Netherlands.
"Management is only partly in accordance with evidence-based medicine."