[Severe, acute bleeding ulcer: which criteria are decisive for therapeutic procedures?].

Prognostic and therapeutic implications of acute severe gastrointestinal bleeding were retrospectively analyzed, on the basis of history, clinical and endoscopic findings, in a group of 50 consecutive patients with endoscopically documented ulcer of the stomach or duodenum. In patients with hemorrhagic shock and a history of melena and/or hematemesis represents the most important indication for urgent action. In this setting the surgical approach remains the therapy of choice if other measures (endoscopic coagulation, somatostatin application) are unable to prevent further bleeding. Except in situations with acute arterial bleeding, the endoscopic finding itself is not decisive in selecting the therapeutic procedure.