Peptic Ulcer Disease
002.5-712,'5/91 $0.00
+
.20
Use of Endoscopy in Peptic Ulcer Disease
Jay]. Mamel, MD*
Acute upper gastrointestinal bleeding results in hospitalization of more than 300,000 individuals annually in the United States. 11 Fiberoptics and video have produced a rcvolutionary change in the diagnosis and treatment of these individuals. The diagnosis of acute upper and lower gastrointestinal bleeding has been greatly facilitated by fiberoptie endoscopy; however, the outcomes from early and accurate diagnosis have not always demonstrated an improvement in survival despite an accuracy of 90%.9. 24 In one series, routine endoscopy was not shown to be of benefit in bleeding patients who ceased bleeding during treatment. 56 The application of upper gastrointestinal endoscopy to the management of acute bleeding and the diagnosis of peptic ulcer disease accounts for the largest percentage of cases reviewed for appropriateness (26%) in a recent evaluation of the use and misuse of endoscopy.36 The accompanying editorial to this report emphasizes the changing nature of the appropriateness for procedures done in 1981 when that evaluation was performed and in 1988 when it was reported. 50 Endoscopy also remains an important technique for the evaluation of gastric outlet obstruction, even in the presence of significant co-morbid conditions. The addition of hemostatic techniques to fiberoptic endoscopy adds another dimension to therapy, particularly for those high-risk patients who are poor candidates for surgical intervention. Peptic ulcer is a term that can be used to describe any break in the gastrointestinal mucosa exposed to gastric acid or pepsin. An erosion is an epithelial defect that does not penetrate the muscularis mucosa and is usually less than 0.5 cm in diameter. Erosions heal rapidly and may occur anywhere on both the acid-secreting and nonacid-secreting mucosa. The depth of erosions is not easily estimated endoscopically; however, smooth peristaltic action is not altered by erosions, whereas deeper ulcers alter the propagation of peristalsis through the lesion. Acute ulcers are often deep and larger than 0.5 cm, penetrate the muscularis mucosa, and have little *Associate Professor of Medicine, and Chief of Nutrition Section, Division of Digestive Diseases and !\'utrition, University of South Florida College of Medicine, Tampa, Florida
Medical Clinics of North America-Vo!' 75, No. 4, July 1991
841
842
JAY
J.
ylA\IEL
fibrous tissue in their base. Chronic ulcers are usually solitary. However, they may be multiple in 6% to 10% of cases, may contain fibrous tissue in their base, and are generally
002.5-712,'5/91 $0.00
+
.20
Use of Endoscopy in Peptic Ulcer Disease
Jay]. Mamel, MD*
Acute upper gastrointestinal bleeding results in hospitalization of more than 300,000 individuals annually in the United States. 11 Fiberoptics and video have produced a rcvolutionary change in the diagnosis and treatment of these individuals. The diagnosis of acute upper and lower gastrointestinal bleeding has been greatly facilitated by fiberoptie endoscopy; however, the outcomes from early and accurate diagnosis have not always demonstrated an improvement in survival despite an accuracy of 90%.9. 24 In one series, routine endoscopy was not shown to be of benefit in bleeding patients who ceased bleeding during treatment. 56 The application of upper gastrointestinal endoscopy to the management of acute bleeding and the diagnosis of peptic ulcer disease accounts for the largest percentage of cases reviewed for appropriateness (26%) in a recent evaluation of the use and misuse of endoscopy.36 The accompanying editorial to this report emphasizes the changing nature of the appropriateness for procedures done in 1981 when that evaluation was performed and in 1988 when it was reported. 50 Endoscopy also remains an important technique for the evaluation of gastric outlet obstruction, even in the presence of significant co-morbid conditions. The addition of hemostatic techniques to fiberoptic endoscopy adds another dimension to therapy, particularly for those high-risk patients who are poor candidates for surgical intervention. Peptic ulcer is a term that can be used to describe any break in the gastrointestinal mucosa exposed to gastric acid or pepsin. An erosion is an epithelial defect that does not penetrate the muscularis mucosa and is usually less than 0.5 cm in diameter. Erosions heal rapidly and may occur anywhere on both the acid-secreting and nonacid-secreting mucosa. The depth of erosions is not easily estimated endoscopically; however, smooth peristaltic action is not altered by erosions, whereas deeper ulcers alter the propagation of peristalsis through the lesion. Acute ulcers are often deep and larger than 0.5 cm, penetrate the muscularis mucosa, and have little *Associate Professor of Medicine, and Chief of Nutrition Section, Division of Digestive Diseases and !\'utrition, University of South Florida College of Medicine, Tampa, Florida
Medical Clinics of North America-Vo!' 75, No. 4, July 1991
841
842
JAY
J.
ylA\IEL
fibrous tissue in their base. Chronic ulcers are usually solitary. However, they may be multiple in 6% to 10% of cases, may contain fibrous tissue in their base, and are generally
