BLEEDING GASTRIC ULCER: A PROSPECTIVE EVALUATION OF REBLEEDING AND MORTALITY

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.