Keep up with the latest news and developments on Capitol Hill, CMS and the FDA. ACG has compiled a wealth of resources to help keep members up-to-date on the latest legislative and regulatory actions that impact the gastroenterology practice, as well as tools to help you manage your practice in light of these changes and take action on important issues. ACG has created a "Take Action Toolkit" to help you speak out for – or against – the issues that matter most to you and your practice. You can make a difference. From health care reform to other legislative and regulatory issues that affect your practice; every voice counts.
H. pylori infection and NSAIDs are the major causes of peptic ulcer bleeding in the United States; therefore, preventive strategies should focus on these etiologies. Smoking and alcohol use impair ulcer healing, and patients should be counseled about smoking cessation and moderation of alcohol use. A systematic review of 41 randomized controlled trials of patients taking NSAIDs found that double-dose H 2 receptor antagonists (relative risk [RR] = ) and PPIs (RR = ) significantly reduced the risk of peptic ulcer bleeding. 27 In patients with a history of peptic ulcer bleeding, aspirin, clopidogrel, and NSAIDs should be avoided if possible. In patients taking aspirin who develop peptic ulcer bleeding, aspirin therapy with PPI therapy should be restarted as soon as the risk of cardiovascular complication is thought to outweigh the risk of rebleeding. 1 A Cochrane review of seven studies of 578 patients with peptic ulcer bleeding concluded that eradication of H. pylori infection reduced the long-term rate of rebleeding ( percent) compared with patients in the noneradication group (20 percent; number needed to treat = 7). 28 In patients with peptic ulcer bleeding associated with H. pylori infection, eradication is essential and should be confirmed by urea breath test, stool antigen test, or biopsy urease test. 1 A repeat upper endoscopy in eight to 12 weeks is recommended for patients with peptic ulcer bleeding secondary to gastric ulcers to assess for healing and to exclude malignancy, and for patients with severe esophagitis to exclude Barrett esophagus.