Bleeding duodenal ulcer: a prospective evaluation of risk factors for rebleeding and death

Probably the most frequent cause of upper gastrointestinal hemorrhage is bleeding duodenal ulcer. A prospective study was undertaken of 433 patients admitted to the hospital with bleeding duodenal ulcer, in order to determine the optimum timing and role of surgery and/or therapeutic endoscopy (visualization of an interior cavity of the body using an illuminated optic instrument). The average age of the patients was 55, and the male:female ratio was approximately 2:1. There were 12 deaths, 11 of which were among 60 years of age and older. Four of these patients had been treated conservatively (without surgery) and eight had undergone emergency operations. Ulcer size was associated with increased incidence of death. Of 288 patients who had endoscopy and initial measurement of the ulcer size, 40 patients (13.9 percent) showed evidence of rebleeding. This was associated with a higher mortality (0.4 versus 12.5). Rebleeding occurred in 13 of 186 patients (7 percent) who did not have evidence of recent hemorrhage. There were 27 patients with rebleeding out of 102 patients (26.5 percent) who did have evidence of recent hemorrhage. Of the 12 deaths, 9 were patients who had no previous history of acute gastrointestinal bleeding. Therapeutic endoscopy was performed on eight patients and all survived. Factors related significantly to outcome were previous medical illness, age greater than 60 years, being in shock at the time of admission and a low hemoglobin level at admission. The most important prognostic factor was endoscopy-documented evidence of recent hemorrhage in ulcers greater than 1 cm in diameter. (Consumer Summary produced by Reliance Medical Information, Inc.)