Audit of mortality in upper gastrointestinal bleeding

Abstract

Summary:The outcome in 1017 patients with haematemesis and malaena referred to two major hospitals in Nottingham within a 2-year period has been prospectively evaluated. Ninety one (9%) patients died during the time period under consideration and all but four were found to have been over 60 years of age. There were 13 (14%) deaths following rebleeding, of whom 5 (5%) could have been potentially avoided by alterations in management. Some improvement of mortality might result from intensive-care facilities with better management of transfusions and earlier detection of rebleeding allowing earlier endoscopy or surgery. The majority of patients (81%), however, died from concomitant disease which was exacerbated by gastrointestinal haemorrhage or bleeding developed in patients with an already existing end-stage disease. These results show that a reduction of mortality in patients with gastrointestinal bleeding is hampered by the high number ofpoor-risk patients. The rise in the proportion ofelderly patients with this disorder seems to continue.

The use of proprietary medicines by patients presenting with peptic ulcer haemorrhage.

“…In addition, this study provides an estimate of the risks associated with patient self-medication in peptic ulcer disease and suggests that the associated symptoms may be more prevalent than previously recognized. The patients examined in the present study appear to be representative of a wider population since the mortality associated with peptic ulcer haemorrhage was similar to that recently reported in a large district general hospital (Katschinski et al, 1989). However, in the study conducted by Katschinski and co-workers (1989) the observed mortality of approximately 10% associated with peptic ulcer haemorrhage fell to about 5% when only death directly associated with bleeding was considered.…”

“…Although changes in the distribution and rates of peptic ulceration have been noted over the last three decades (Coggan et al, 1981) mortality is still significant with recent studies providing estimates of about 5% in patients with peptic ulcer haemorrhage (Daneshmend et al, 1992;Holman et al, 1990;Katschinski et al, 1989;Walt et al, 1991). However, a relative increase in the incidence of gastrointestinal haemorrhage has also been demonstrated in the elderly (Bardhan et al, 1989).…”

Frequency, Determinants and Outcome of Upper Gastrointestinal Bleed among Patients with Liver Cirrhosis

“…4 patients were lost to follow up. In a study conducted by Katschinski et al 29 , death occurred in 189 (8.5%) patients, and 243 (11%) patients experienced rebleeding. Zaltmanet al 30 showed Rebleeding in 9.1% of the patients and overall mortality rate of 15.34%.…”

Misoprostol—a Logical Therapeutic Approach to Gastroduodenal Mucosal Injury Induced by Non-Steroidal Anti-Inflammatory Drugs?

“…Approximately 30,000 people are admitted to hospital each year in the U.K. with upper G I bleeding ranging across a broad spectrum. About 20°4, of these require surgery, and the death rate is approximately 10% (134).…”