Pathophysiology

• Peptic ulcer erodes through the mucosa of the stomach or duodenum - erodes through blood vessel
• Accounts for 50% of upper GI bleeds
• GUs on lesser curvature may cause massive haemorrhage of left gastric artery
• DUs on posterior wall are more likely to cause massive bleeding due to proximity to gastroduodenal artery

Clinical features

• Haematemesis
• Melaena
• Abdominal discomfort
• Dizziness
• Sudden death

Investigations

• Endoscopy

Management

• Endoscopic treatment - adrenaline injection, heater probe coagulation, clips, haemospray
• IV omeprazole
• Theatre/patch repair if necessary (if can’t stop bleeding/rebleeding)
• Eradicate H. pylori and start on PPIs