Skip to main content
SpringerLink
Log in

Outcome of peptic ulcer hemorrhage treated according to a defined approach

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The short- and long-term bleeding recurrence and mortality of 157 consecutive patients admitted emergently over a period of 2 years with in 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.

Résumé

Les taux de récidives et de mortalité ont été analysés pendant une période d'observation de deux ans chez 157 patients consécutifs opérés en urgence pour un ulcère saignant activement. Ces patients ont été traités de façon homogène selon un protocole dans lequel l'intervention était précoce. La survie a été analysée selon la méthode actuarielle. Il y avait 94 hommes, la médiane d'âge a été de 72.3 ans. Quatre-vingt trois ulcères étaient gastriques, 74 duodénaux. Trente et un patients ont été opérés. Onze des 157 patients (7%) sont décédés pendant le premier mois. Pendant le suivi, 13 patients ont resaigné, 54 sont décédés, deux en rapport avec leur ulcère. Le risque cumulé de récidive hémorragiqueà 5 ans a été de 11.8% et ne différait pas selon l'âge (<60 ans vs>60 ans), le sexe, la localisation de l'ulcère (gastrique vs duodénal) ou le type de traitement (conservateur vs chirurgical). Selon une approche bien définie, et avec une intervention précoce, la mortalité à court terme dans cette série se compare favorablement avec celle de la littérature, qui est de 10% ou plus. La mortalité élevée dans le suivi est un reflet seulement de l'âge avancé des patients ayant des maladies concommitantes. Le suivi rapporté ici peut éventuellement servir de standard auquel peuvent être comparées de nouvelles stratégies thérapeutiques.

Resumen

Se hizo un análisis de la recidiva de sangrado a corto y largo plazo y de la mortalidad de 157 pacientes consecutivos hospitalizados con úlcera péptica sangrante en un período de dos años.

Todos fueron tratados de acuerdo a una conducta definida que incluye operación precoz en pacientes debidamente seleccionados. El análisis del seguimiento a cinco años fue realizado mediante la construcción de tablas de vida. El grupo incluyó 94 hombres; la edad promedio fue 72.3 años. Ochenta y tres de las úlceras fueron gástricas y 74 duodenales. Treinta y un pacientes fueron sometidos a operación. Once pacientes (7%) murieron en el curso del primer mes, uno de ellos en el subgrupo quirúrgico. En el período total de seguimiento se registraron 13 pacientes con sangrado recurrente y 54 murieron, dos debido a enfermedad péptica. La tabla de vida para resangrado y muerte relacionada con úlcera señaló un ríesgo acumulativo de 11.8% a 5 años y el riesgo acumulativo no fue estadísticamente diferente entre los pacientes según su edad (mayores o menores de 60 años), sexo, ubicación de la úlcera (gástrica vs. duodenal) o tipo de tratamiento (conservador vs. quirúrgico).

Con una conducta de manejo bien definida que incluye cirugía precoz en pacientes seleccionados, la mortalidad a corto plazo se compara favorablemente con la tasa usual de 10% o má que informa la literatura. La elevada tasa de mortalidad observada en el seguimiento a largo plazo refleja la edad avanzada de los pacientes con enfermedad coexistente.

El presente estudio de seguimiento a largo plazo puede ser utilizado como punto de comparación para valorar la eficacia de nuevas modalidades terapéuticas en futuros estudios.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Graham, D.Y.: Should emergency endoscopy be utilized in the management of upper gastrointestinal bleeding of unknown cause? Negative. In Controversies in Gastroenterology, G. Gitnick, editor. New York, Churchill Livingstone, 1984, pp. 153–169

    Google Scholar 

  2. Borland, J.L., Hancock, W.R., Borland, J.L.: Recurrent upper gastrointestinal hemorrhage in peptic ulcer. Gastroenterology 52:631, 1967

    Google Scholar 

  3. Grace, W.J., Mitty, W.F.: Does subtotal gastrectomy in bleeding peptic ulcer prevent recurrence of bleeding? Am. J. Dig. Dis. 7:69, 1962

    Google Scholar 

  4. Johansson, C., Barany, F.: A retrospective study on the outcome of massive bleeding from peptic ulceration. Scand. J. Gastroenterol. 8:113, 1973

    Google Scholar 

  5. Leape, L.L., Welch, C.E.: Late prognosis of patients with upper gastrointestinal hemorrhage. Am. J. Surg. 107:297, 1964

    Google Scholar 

  6. Serebro, H.A., Mendeloff, A.I.: Late results of medical and surgical treatment of bleeding peptic ulcer. Lancet 2:505, 1966

    Google Scholar 

  7. Chinn, A.B., Litell, A.S., Badger, G.F., Beams, A.J.: Acute hemorrhage from peptic ulcer: a follow-up study of 310 patients. N. Engl. J. Med. 255:973, 1956

    Google Scholar 

  8. Müller, C.: Ulkusblutung. In Die proximale selektive Vagotomie in der Behandlung der gastro-duodenalen Ulkuskrankenheiten, C. Müller, S. Martinolli, editors, Berlin, Springer, 1985, pp. 187–211

    Google Scholar 

  9. Panès, J., Viver, J., Forné, M., Garcia-Olivares, E., Marco, C., Garau, J.: Controlled trial of endoscopic sclerosis in bleeding peptic ulcer. Lancet 2:1292, 1987

    Google Scholar 

  10. Chung, S.C.S., Leung, L.W.C., Steele, R.J.C., Crofts, T.J., Li, A.K.C.: Endoscopic injection of adrenaline for actively bleeding ulcers: a randomised trial. B.M.J. 296:1631, 1988

    Google Scholar 

  11. Coldman, A.J., Elwood, J.M.: Examining survival data. Can. Med. Assoc. J. 121:1065, 1979

    Google Scholar 

  12. Silverstein, F.E., Gilbert, D.A., Tedesco, F.J., Buenger, N.K.: The national ASGE survey on upper gastrointestinal bleeding. I. Study design and baseline data. Gastrointest. Endosc. 27:73, 1981

    Google Scholar 

  13. Morgan, A.G., Clamp, S.E.: OMGE international upper gastrointestinal bleeding survey, 1978–1986. Scand. J. Gastroenterol. 23(Suppl. 144):51, 1988

    Google Scholar 

  14. Troidl, H., Vestweber, K.H., Kusche, J., Bouillon, B.: Die Blutung beim peptischen Gastroduodenalulcus: Daten als Entscheidungshilfe für ein chirurgisches Therapiekonzept. Chirurg 57:372, 1986

    Google Scholar 

  15. Jones, A.F.: Haematemesis and melena: with special reference to causation and to the factors influencing the mortality from bleeding peptic ulcers. Gastroenterology 30:166, 1956

    Google Scholar 

  16. Allan, R., Dykes, P.: A study of the factors influencing mortality rates from gastrointestinal haemorrhage. Q. J. Med. 45:533, 1976

    Google Scholar 

  17. Silverstein, F.E., Gilbert, D.A., Tedesco, F.J., Buenger, N.K.: The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors. Gastrointest. Endosc. 27:80, 1981

    Google Scholar 

  18. Hunt, P.S.: Surgical management of bleeding chronic peptic ulcer: a 10-year prospective study. Ann. Surg. 199:44, 1984

    Google Scholar 

  19. Jeans, P.L., Padbury, R.T., Toouli, J.: A prospective evaluation of the management of bleeding peptic ulcer. Aust. N.Z. J. Surg. 61:187, 1991

    Google Scholar 

  20. Wheatley, K.E., Dykes, P.W., Keighley, M.R.: Effect of a defined policy on the outcome of bleeding peptic ulcer disease. Gut 29:A1472, 1988

    Google Scholar 

  21. Ceballos, C.J., de Duenas, M.J., Collado, D.E., Martos, G.J.: Descenso de la mortalidad postoperatoria de la ulcera peptica sangrante. Rev. Esp. Enterm. Ap. Dig. 75:671, 1989

    Google Scholar 

  22. Smart, H.L., Langman, M.J.: Late outcome of bleeding gastric ulcer. Gut 27:926, 1986

    Google Scholar 

  23. Boles, R.S., Cassidy, W.J., Jordan, S.M.: Medical versus surgical management for complication of haemorrhage in duodenal ulcer. Gastroenterology 32:52, 1957

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Kantonsspital, Basel University, Spitalstrasse 21, 4031, Basel, Switzerland

    Xavier Mueller M.D., Jean-Marc Rothenbuehler M.D., Beat Meyer M.D. & Felix Harder M.D.

  2. Department of Gastroenterology, Kantonsspital, Basel University, Spitalstrasse 21, 4031, Basel, Switzerland

    Xavier Mueller M.D., Jean-Marc Rothenbuehler M.D. & Beat Meyer M.D.

  3. Department of Surgery, Frimley Park Hospital NHS Trust, Portsmouth, GU16 5UJ, Frimley, Surrey, UK

    Anthony Amery M.D. & Felix Harder M.D.

Authors
  1. Xavier Mueller M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Marc Rothenbuehler M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony Amery M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beat Meyer M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Felix Harder M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mueller, X., Rothenbuehler, JM., Amery, A. et al. Outcome of peptic ulcer hemorrhage treated according to a defined approach. World J. Surg. 18, 406–409 (1994). https://doi.org/10.1007/BF00316821

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00316821

Keywords

Search

Navigation