Clinical laboratory and endoscopic data were collected prospectively in 268 patients with bleeding gastric ulcer who were admitted between september 1985 and november 1987. There were 22 deaths, giving a hospital mortality rate of 8.2%. Surgery was undertaken in 68 patients (25.4%) with a mortality rate of 17.6% (11.8% al 30 days). There was one fatality in 104 (1.0%) patients > 60 years compared with 21 deaths (12.8%) in patients > 60 years (p > 0.001). Cirrhosis (p > 0.01), malignant disease (p < 0.03), chronic obstructive airways disease (p < 0.02), congestive cardiac failure (p < 0.02) and ischaemic heart disease (p < 0.08) were each associated with an increased risk of mortality. Outcome in patients > 60 years was related to systolic blood pressure at admission (p < 0.03), haemoglobin (p < 0.02), serum bilirubin (p < 0.02), and total transfusion requirements (p < 0.001). For ulcers 1 cm, 1‐< 2cm, > 2cm in size, mortality rates were 1.9%, 11.4% and 18.0%, respectively. Initial endoscopy findings of a visible vessel, fresh blood, or active spurting/oozing haemorrhage were associated with rebleeding rates necessitating emergency surgery of 30.0%, 36.4% and 40.0%, respectively. There was no evidence of rebleeding in 187 patients (79.9%) managed conservatively and only five patients (2.7%) in this group succumbed, whereas rebleeding did occur in 47 patients (20.1 %) with 13 subsequent deaths (27.7%) (p < 0.001). In patients > 60 years the presence of endoscopic stigmata of recent haemorrhage should lead to early consideration of therapeutic endoscopy and/or early surgery, particularly for ulcers > 1 cm in size.
|Number of pages||12|
|Journal||Australian and New Zealand Journal of Surgery|
|Publication status||Published - Jul 1989|
- gastric ulcer
- gastrointestinal haemorrhage
- peptic ulcer.
ASJC Scopus subject areas