A Current Approach to Acute Upper Gastrointestinal Bleeding

Kinard, H. Bennett; Powell, Don W.; Sandler, Robert S.; Callahan, W. Tom; Lapis, J; Levinson, Sidney L.; Jones, Jeffrey; Drossman, Douglas A.; Jackson, Alto L.

doi:10.1097/00004836-198109000-00006

Cited by 13 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Peptic ulcer bleeding consumes substantial resources and requires proficiency in clinical and endoscopic skills for a successful outcome. This is particularly evident in the management of elderly patients as the mortality rate increases from less than 10 per cent for those younger than 60 years to 35 per cent for octogenarians 2 . The high mortality rate in the latter group of patients has not changed over the past 30 years despite improvements in diagnostic techniques and advances in intensive medical care and surgical strategies.…”

mentioning

confidence: 99%

Risk factors for rebleeding and death from peptic ulcer in the very elderly

Chow

Gertsch

Poon

et al. 1998

Journal of British Surgery

View full text Add to dashboard Cite

Patients aged 80 years or greater had the highest risk of rebleeding and death. For patients below 80 years of age, significant factors related to a fatal outcome included co-morbid illness, complications and the need for mechanical ventilation. For patients aged 80 years or older, the significant factors were ulcer size greater than 2 cm and admission with serum bilirubin level above 20 mmol/l. Endoscopic treatment for the very elderly was effective if carried out early.

show abstract

mentioning

confidence: 99%

Risk factors for rebleeding and death from peptic ulcer in the very elderly

Chow

Gertsch

Poon

et al. 1998

Journal of British Surgery

View full text Add to dashboard Cite

show abstract

“…Age, coexistent disease, and recurrent bleeding in-hospital influence survival in patients with bleeding peptic ulcer whether treatment is medical or surgical [8][9][10]. Mortality among such patients increases from less than 10% for those under 60 years of age to greater than 35% for octogenarians [11]. Greater sensitivity in identifying high-risk patients is likely to result from a consideration of additional risk factors, rather than a more minute analysis of endoscopic findings [12].…”

mentioning

confidence: 99%

Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality

et al. 1990

View full text Add to dashboard Cite

Clinical, endoscopic, and laboratory data were collected prospectively in 701 patients with bleeding peptic ulcer. The overall rebleeding rate was 16.1% and increased the risk of a fatal outcome by 17 fold (1.2% versus 20.6%, p less than 0.001). Rebleeding was documented in more than 75% of the group who did not survive following initial conservative management. Rebleeding was more likely (24.1% versus 14.2%, p less than 0.02) when shock was present on admission and the risk of a rebleed was doubled in patients over 60 years of age (22.1% versus 10.9%, p less than 0.001). Ulcers greater than 1 cm in size carried twice the risk of rebleeding (23.9% versus 12.4%, p less than 0.002). Concomitant medical illness had a significant adverse effect on outcome (p less than 0.05). Shock on admission was associated with a doubling of mortality figures (9.5% versus 3.7%, p less than 0.01). The identification of endoscopic stigmata of recent hemorrhage (ESRH) tripled the risk of mortality (7.5% versus 2.4%, p less than 0.002), ESRH were more frequently encountered when ulcer size was larger than 1 cm (61.4% versus 39.8%, p less than 0.001). Respective mortality rates for ulcers less than or equal to 1 cm and greater than 1 cm in size were 1.6% and 12.5% (p less than 0.001), corresponding mortality figures for patients over 60 years of age being 4.4% and 16.4% (p less than 0.002). The risk of a rebleed tripled (6.7% versus 2.6%, p less than 0.02) when ESRH were evident. There was a 6-fold increase in mortality following emergency surgery when compared with conservative management of patients in whom no surgical intervention was necessary (2.6% versus 14.9%, p less than 0.001). In summary, age over 60 years, previous medical illness, shock on admission, large ulcer size, and ESRH were each associated with an increased risk of rebleeding and mortality.

show abstract

“…Seventeen years ago, a 35% mortality rate from ulcer haemorrhage was reported in patients > 80 years of age 17 . Between 1985 and 1993, we undertook therapeutic endoscopy in 301 of 1744 patients (17.3%) with bleeding peptic ulcer, 205 of whom (11.8%) were > 80 years old.…”

Section: Rebleeding and Mortalitymentioning

confidence: 99%

Bleeding peptic ulcer: An evolving role for surgical intervention

Branicki

Ting

Gertsch

et al. 1998

J of Gastro and Hepatol

View full text Add to dashboard Cite

Early surgical intervention was previously advocated in patients > 60 years with bleeding peptic ulcer presenting with haemodynamic instability or ongoing transfusion requirements. It is, however, well recognized that emergency surgical intervention with its inherent risks must be reserved for highly selected patients in whom endoscopy initially fails to control exsanquinating haemorrhage or in whom life‐threatening bleeding recurs. Therapeutic endoscopy for bleeding ulcer has led to a remarkable decline in rebleeding rates, the need for emergency surgery and mortality. Octogenarians are at risk, particularly when ulcer size exceeds 2 cm. Poor surgical candidates make up two‐thirds of patients with major ulcer bleeding and operation is to be avoided if at all possible. Medical therapy with proton pump inhibitor and subsequent eradication of Helicobacter pylori following endoscopic treatment has been shown to be beneficial to outcomes. Should surgery be deemed necessary, it is likely that laparoscopic techniques to control bleeding, with or without the addition of an acid‐reducing procedure, will find a role in haemodynamically stable patients undergoing operation on an early elective basis.

show abstract

A Current Approach to Acute Upper Gastrointestinal Bleeding

Cited by 13 publications

References 0 publications

Risk factors for rebleeding and death from peptic ulcer in the very elderly

Risk factors for rebleeding and death from peptic ulcer in the very elderly

Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality

Bleeding peptic ulcer: An evolving role for surgical intervention

Contact Info

Product

Resources

About