Outcome of peptic ulcer hemorrhage treated according to a defined approach

Abstract

The short- and long-term bleeding recurrence and mortality of 157 consecutive patients admitted emergently over a period of 2 years with an actively bleeding peptic ulcer were analyzed. They were treated uniformly according to a defined approach where suitable candidates for surgery were operated on early. The data of the 5-year follow-up were analyzed by constructing life tables. There were 94 men and 63 women with a median age of 72.3 years; 83 ulcers were gastric and 74 duodenal. Thirty-one patients underwent an operation. Eleven patients (7%) died within the first month, one in the surgical group. During the follow-up 13 patients rebled and 54 died, two of the deaths related to peptic ulcer disease. The life table for rebleeding and ulcer-related deaths showed a cumulative risk of 11.8% at 5 years, and the cumulative risk was not statistically different between patients according to their age (60 years and older versus younger), sex, the site of their ulcer (gastric versus duodenal), or the type of treatment (conservative versus surgical). With a well defined approach and early selective surgery, the short-term mortality compares favorably with the usual 10% or more reported. The high mortality rate during the follow-up reflects the advanced age of patients with coexisting disease. This long-term follow-up study could be used as a comparison against future studies evaluating new therapies.

Surgical Indications and Procedures for Bleeding Peptic Ulcer

“…performed surgery on 66 patients with shock on admission, aged older than 65 years, with an ulcer size greater than 2 cm, or with stigmata of recent bleeding and previous admission for ulcer plication; none of these patients died over a 5‐year period. Mueller et al 16 . operated on patients with spurting bleeding, nonbleeding visible vessels on posterior duodenal ulcers, blood transfusion greater than 6 units in the first 24 hours, and rebleeding within 48 hours.…”

Management of Acute Gastric Ulcer Bleeding

“…Early elective surgery in patients presenting with arterial bleeding or a visible vessel of ≥2 mm is superior to endoscopic retreatment and has a relatively low overall mortality rate of 5% (Imhof et al, 1998(Imhof et al, & 2003. Additional indications for early elective surgery include age >65 years, previous admission for ulcer plication, blood transfusion of more than 6 units in the first 24 hours and rebleeding within 48 hours (Bender et al, 1994;Mueller et al, 1994). This approach is associated with a low 30-day mortality rate as low as 7%.…”