Bleeding duodenal ulcer. A prospective evaluation of risk factors for rebleeding and death

There were 12 hospital deaths in 433 patients (2.8%, 1.6% at 30 days) presenting with bleeding duodenal ulcer. Excluding patients who underwent immediate operation or early elective surgery, where ulcer size was measured at initial endoscopy rebleeding was evident in 40/228 patients (13.9%) and was associated with an increased mortality (0.4% v 12.5%) (p<0.0001). Rebleeding rates for ulcers ≤ 1 cm were respectively 28/239 (11.7%) and 12/49 (24.5%) (p<0.02). Rebleeding occurred in 13/186 patients (7.0%) in whom endoscopic stigmata of recent haemorrhage were absent and in 27/102 (26.5%) with such stigmata was 3/186 patients (7.0%) in whom indoscopic stigmata of recent haemorrhage were absent and in 27/102 (26.5%) with stigmata (p<0.0001). The mortality rate for patients without stigmata was 3/186 (1.6%) whilst mortality figures for patients with ulcers ≤ 1 cm and > 1 cm in size were respectively 0/77 and 3/25 (12.0%) when stigmata were identified. Ulcers > 1 cm were more frequent in the > 60 year age group, more likely to have stigmata and carried an increased risk of rebleeding and mortality