Treatment Options for Duodenal Ulcer Bleeding

When a patient experiences bleeding from a duodenal ulcer, it is crucial to seek immediate care from a gastroenterology specialist. Treatment typically involves intravenous nutritional support, oxygen therapy, medication, and in some cases, endoscopic or interventional procedures. These interventions aim to stop the bleeding and prevent complications such as anemia due to prolonged blood loss.

Initial Medical Support

Intravenous (IV) nutritional support is often the first step in managing duodenal ulcer bleeding. Patients are advised to remain in bed and avoid eating or drinking to prevent irritation to the ulcer site, which could worsen the bleeding. IV fluids help maintain hydration, provide essential nutrients, and restore electrolyte balance. In some cases, supplemental oxygen may also be administered to support tissue oxygenation.

Oxygen Therapy

Oxygen therapy may be recommended to help maintain adequate oxygen levels in the blood, especially if significant blood loss has occurred. Reduced hemoglobin levels can impair the body's ability to transport oxygen, potentially leading to hypoxia and further health complications.

Pharmacological Treatments

Acid-Suppressing Medications

Medications such as H2 receptor antagonists (e.g., cimetidine, ranitidine) and proton pump inhibitors (e.g., omeprazole, pantoprazole) are commonly prescribed to reduce gastric acid production. Lowering stomach acidity helps protect the ulcer site and promotes healing.

Hemostatic Agents

For patients with minor bleeding, intravenous hemostatic drugs like tranexamic acid or carbazochrome may be used to help control and stop the bleeding.

Endoscopic Interventions

For moderate or persistent bleeding, endoscopic therapy is often effective. This may include local injection of epinephrine, thermal coagulation using microwave or laser techniques, or other endoscopic methods to achieve hemostasis. These procedures are minimally invasive and usually performed under sedation.

Interventional Radiology

If endoscopic treatment is not sufficient, angiographic embolization may be considered. Under medical supervision, the left gastric artery or gastroduodenal artery can be selectively embolized to cut off blood supply to the bleeding site, effectively stopping the hemorrhage.

Surgical Intervention

In cases of severe hemorrhage or when ulcers are malignant, surgical treatment such as partial gastrectomy may be necessary. This procedure removes the affected portion of the stomach and ensures rapid control of life-threatening bleeding.

Post-Treatment Care and Dietary Management

After treatment, patients typically experience significant improvement. However, dietary adjustments are essential during recovery. Initially, patients should consume liquids and gradually progress to soft or semi-soft foods. Spicy, acidic, or irritating foods should be avoided to prevent recurrence or irritation of the healing ulcer.