Research: International team validates treatment of the most serious bleeding peptic ulcers

By Sarah Zulkifli, Science Writer, Communications & Outreach

A LKCMedicine-led study has validated a medical technology that could improve the treatment of the most serious bleeding peptic ulcers, which affect an estimated eight per cent of the world’s population.

Led by Professor Joseph Sung, LKCMedicine Dean and NTU Senior Vice-President (Health & Life Sciences), the international team of gastroenterologists reported that applying a mineral powder directly to the ulcers using an endoscope had a 91 per cent success rate in stopping bleeding and starting the healing process, in a study of 67 patients diagnosed with the most serious forms of peptic ulcers. 

Combined with other treatments, the mineral powder had a success rate of 97 per cent. The study, which involved doctors from hospitals¹ and universities² in Canada, the United Kingdom, The Netherlands, and Hong Kong, also reported that the mineral powder was found to be easy and effective to administer, with a success rate of 88 per cent after being applied once.

The results of the study were published in the peer-reviewed academic journal Gastrointestinal Endoscopyin March.  

Peptic ulcers are open sores that develop on the inside lining of the stomach and the upper portion of the small intestine. They are mostly caused by the bacterium Helicobacter pylori and long-term use of nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen sodium.

Elderly populations are particularly affected by peptic ulcers. If left untreated, they can result in internal bleeding in a fifth of cases, which results in death in up to 10 per cent of cases, according to the team of doctors.

The ulcers can also result in complications such as a hole in the stomach wall, blocked passage of food through the digestive tract, as well as a higher risk of developing gastric cancer. 

The study was to evaluate the safety and effectiveness of the technology, named Hemospray®, as a singular therapy for patients with actively bleeding peptic ulcers. It was developed by Cook Group, an American medical devices manufacturer, and had shown promise in treating peptic ulcers, but required further studies into its efficacy. 

In the presence of active bleeding, Hemospray® ejects a mineral powder to form a barrier on contact with the peptic ulcer to stop bleeding. It is nontoxic and is neither absorbed nor metabolised by the body, being expelled from the stomach and duodenum within 72 hours of administration.

Prof Sung said, “Peptic ulcers and their complications, especially bleeding and re-bleeding, are one of the most difficult conditions for gastroenterologists to treat. Despite recent advances in treatments for the disease, ulcers lead to high morbidity, particularly among the elderly. With our global study evaluating the effectiveness of this novel treatment, we hope that progress can be made into improving the treatment and outlook of those suffering from peptic ulcers.”

One of the world’s most renowned gastroenterologists whose research has had a major impact on the practice of gastroenterology, Prof Sung led a team of doctors to first prove the relationship between Helicobacter pylori and peptic ulcer diseases. His team was also first in demonstrating that a course of antibiotics lasting a week can cure the bacterial infection and successfully treat peptic ulcers and minimise their relapse.

Hemospray® has been used to treat thousands of patients for gastrointestinal bleeding throughout Europe and Canada and was granted approval from the US Food and Drug Administration for mainstream use in 2018. 

With this study demonstrating its efficacy in patients with active bleeding peptic ulcers, the doctors are working towards further understanding its effect on other types of bleeding in the gastrointestinal tract, as well as if it is effective for subsequent use on peptic ulcers that bleed again. 

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Footnotes:

¹ Bradford Teaching Hospitals Foundation Trust, Nottingham University Hospitals NHS Trust, the Ottawa Hospital, Ottawa, Ontario, Canada, Royal Alexandra Hospital, Edmonton, Alberta, Canada, Vancouver General Hospital, Vancouver, British Columbia, Canada 

² University of Manitoba, Canada, Western University, Canada, McGill University, Canada, Erasmus University Medical Center, The Netherlands, and The Chinese University of Hong Kong