Combination Therapy Injection Therapy Thermocoagulation

Many centers combine injection therapy and thermocoagulation for the endoscopic control of bleeding peptic ulcers. Injection therapy is carried out first followed by thermocoagulation. Supportive evidence includes the study by Lin and colleagues (1999) in which 96 patients with active peptic ulcer bleeding or nonbleeding visible vessels were randomized to receive either epinephrine, BPEC, or combination therapy. Recurrent bleeding episodes were fewer and the volume of blood transfused was less in the combination therapy group compared to the other two groups. No differences were observed in the rates of emergency surgery and mortality among the three groups.

High risk patients with arterial spurting may receive a greater benefit from combination therapy. A study by Chung and colleagues (1997) randomized 276 patients with actively bleeding ulcers to either epinephrine injection or epinephrine plus HP. Overall, there were no differences in the rates of initial hemostasis, recurrent bleeding, mortality, and blood transfusion. However, the subgroup of patients with arterial spurting had shorter hospital stays (4 d vs 6 d, p = .01) and less need for emergency surgery (6.5% vs 29.6%, p = .03).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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