Marshall and Warren Lecture 2009: peptic ulcer bleeding: an expedition of 20 years from 1989-2009.

Peptic ulcer bleeding is one of the most common medical emergencies leading to substantial mortality and morbidity. The last two decades has witnessed some important advances in the management of this condition, and some of these are results from clinical trials conducted in the Asia Pacific region. The optimal use of combined endoscopic hemostasis and the use of pharmacologic control of acid secretion in the stomach have significantly improved clinical outcome. The role of surgery has been redefined. Treatment of Helicobacter pylori infection and prophylactic treatment in non-steroidal anti-inflammatory drug and anti-platelet users have made progress in preventing recurrence of peptic ulcer and bleeding. Instead of merely focusing on safety in the gastrointestinal tract, striking a balance between risk and benefit of continuing anti-platelet agents should be a top agenda.