Skip to main content
SpringerLink
Log in

Bleeding peptic ulcer occurring in hospitalized patients

Analysis of predictive and risk factors and comparison with out-of-hospital onset of hemorrhage

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

We reviewed 84 consecutive cases of peptic ulcer hemorrhage, which occurred, in an area of 270,000 people, from 1986 to 1988, in patients already hospitalized for other diseases (in-bleeders). These subjects were compared with a prospective series of 386 patients who initially bled as out-patients and were then admitted (out-bleeders). Of 84 hemorrhages in hospitalized patients, 41 followed major surgery, while 43 were associated with other severe conditions. Bleeding site was duodenal in two thirds. Mean age was 67 ± 15 years versus 59 ± 15 among out-bleeders. Fifty percent of in-bleeders had recently received nonsteroidal antiinflammatory drugs (NSAIDs), and one third were on anticoagulants and 10% on corticosteroids; in 39 (46%) bleeding was shown to be persistent or recurrent, 5 (5.9%) underwent endoscopic and 18 (21%) surgical therapy; 29 died (34%). The corresponding figures among out-bleeders were: further bleeding 80 (20.7%), endoscopic therapy 12 (3.1%), surgery 25 (6.5%), deaths 17 (4.4%). As regards in-bleeders, only active bleeding and endoscopic stigmata emerged as statistically significant risk factors for further bleeding. The latter was shown to be significantly related to mortality. The most relevant finding was, however, that NSAIDs and anticoagulants, in association with stress and aging, are very frequently involved in peptic ulcer bleeding of hospitalized patients. The fatal outcome of one third, despite all available treatments, highlights the importance of prevention against drug- and stress-related mucosal damage in in-patients suffering from severe diseases.

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. Schiller KRF, Truelove SC, Williams DG: Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J 2:7–14, 1970

    Google Scholar 

  2. Johnston SJ, Jones PF, Kyle J, Needham CD: Epidemiology and course of gastrointestinal haemorrhage in north-east Scotland. Br Med J 3:655–660, 1973

    Google Scholar 

  3. Silverstein FE, Gilbert DA, Tedesco FJ, Buenger NK, Persing J, and 277 members of the ASGE: The national ASGE survey on upper gastrointestinal bleeding. Gastrointest Endosc 27:73–103, 1981

    Google Scholar 

  4. Domschke W, Lederer P, Lux G: The value of emergency endoscopy in upper gastrointestinal bleeding: Review and analysis of 2014 cases. Endoscopy 15:126–131, 1983

    Google Scholar 

  5. Vellacott KD, Dronfield MW, Atkinson M, Langman MJS: Comparison of surgical and medical management of bleeding peptic ulcers. Br Med J 284:548–550, 1982

    Google Scholar 

  6. Boersch G, Matuk Z, Leverkus F: Zur Prognose der akuten oberen Gastrointestinalblutung. Univariate und multivariate Analysen in 477 Blutungsepisoden. Med Klin 82:774–780, 1987

    Google Scholar 

  7. Loperfido S, Monica F, Vallenari A, Dematté P, Fabi F, Di Falco G, Di Natale I: Epidemiologia dell'emorragia del tratto digestivo superiore in una provincia italiana. G Ital Endosc Dig 11:45–56, 1988

    Google Scholar 

  8. Branicki FJ, Coleman SY, Fok PJ, Pritchett J, Sheung tat Fan, Lai ECS, Mok FPT, Wai-lam Cheung, Lau PWK, Tuen HH, Shiu-kim Lam, Wai-mo Hui, Ng MMT, Lam DKH, Tse MCK, Tang APK, Wong J: Bleeding peptic ulcer: A prospective evaluation of risk factors for rebleeding and mortality. World J Surg 14:262–270, 1990

    Google Scholar 

  9. Fullarton GM, Birnie GG, Mac Donald A, Murray WR: The effect of introducing endoscopic therapy on surgery and mortality rates for peptic ulcer hemorrhage. A single center analysis of 1,125 cases. Endoscopy 22:110–113, 1990

    Google Scholar 

  10. Kim B, Hastings K, Bordan D, Fielding LP, Swaney R: Risks of surgery for upper gastrointestinal hemorrhage: 1972 versus 1982. Am J Surg 149:474–476, 1985

    Google Scholar 

  11. Heldwein W, Schreiner J, Pedrazzoli J, Lehnert P: Is Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers? Endoscopy 21:258–262, 1989

    Google Scholar 

  12. Fleischer D: Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology 84:538–543, 1983

    Google Scholar 

  13. Collins R, Scrimagear A, Yusuf S, Fielding LP, Swaney R: Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin—overview of results of randomized trials in general, orthopaedic and urologic surgery. N Engl J Med 318:1162–1173, 1988

    Google Scholar 

  14. Mellem H, Stave R, Myren J, Osnes M, Hanssen LE, Mosvold J, Hebnes K: Symptoms in patients with peptic ulcer and hematemesis and/or melena related to the use of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol 20:1246–1249, 1985

    Google Scholar 

  15. Armstrong CP, Blower LAL: Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut 28:527–532, 1987

    Google Scholar 

  16. Bank S, Misra P, Mausner D, Kurtz L, Rehman M, Wise L. The incidence, distribution and evolution of stress ulcers in surgical intensive care patients. Am J Gastroenterol 74:76, 1980

    Google Scholar 

  17. Schoon IM, Mellstrom D, Odén A, Ytterberg BO: Incidence of peptic ulcer disease in Gothenburg, 1985. Br Med J 299:1131–1134, 1989

    Google Scholar 

  18. Pounder R: Silent peptic ulceration: Deadly silence or golden silence. Gastroenterology 96:626–631

  19. Fusamoto H, Hagiwara H, Meren H, Kasahara A, Hayashi N, Kawano S, Sugimoto T, Kamada T: A clinical study of acute gastrointestinal hemorrhage associated with various shock states. Am J Gastroenterol 86:429–433, 1991

    Google Scholar 

  20. Fries JF, Miller SR, Spitz PW, Williams CA, Hubert HB, Bloch DA: Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use. Gastroenterology 96(suppl):647–655, 1989

    Google Scholar 

  21. McClave SA, Goldschmid S, Cunnungham JT, Boyd WP: Dieulafoy cirsoid aneurism of the duodenum. Dig Dis Sci 33:801–805, 1988

    Google Scholar 

  22. Bank S: Stress ulcers—prevention of gastrointestinal bleeding in critical care units. Med J Aust 142:S17–S20, 1985

    Google Scholar 

  23. Mel Wilcox C: Stress ulcer prophylaxis in medical patients: Who, what, and how much? Am J Gastroenterol 83:1199–1211, 1988

    Google Scholar 

  24. Lacroix J, Infante-Rivard C, Jenicek M, Gauthier M: Prophylaxis of upper gastrointestinal bleeding in intensive care units: A meta-analysis. Crit Care Med 17:862–869, 1989

    Google Scholar 

  25. Zinner MJ, Zuidema GD, Smith PL, Mignosa M: The prevention of gastrointestinal tract bleeding in patients in intensive care units. Surg Gynecol Obstet 153:214–220, 1981

    Google Scholar 

  26. Christiansen J, Ottenjann R, Von Arx F, and the Study Group: Placebo-controlled trial with the somatostatin analogue SMS 201–995 in peptic ulcer bleeding. Gastroenterology 97:568–574, 1989

    Google Scholar 

  27. Peterson WL: Pharmacotherapy of bleeding peptic ulcer. Is it time to give up the search? Gastroenterology 97:796–797, 1989

    Google Scholar 

  28. Hubert JP, Kiernan PD, Welch JS, Remine WH, Behars OH: The surgical management of bleeding stress ulcers. Ann Surg 191:672–679, 1980

    Google Scholar 

  29. Consensus Conference: Therapeutic endoscopy and bleeding ulcers. JAMA 262:1369–1372, 1989

    Google Scholar 

  30. Castell DO, Blankenbaker RG, Bozymski EM, Bulkley GB, Elashoff JD, Galambos JT, Harmon JW, Knauer CM, Krishamurthy S, Moser RH, Ransohoff DF, Russell RM, Sampliner RE, Scott IG, Szurszewski JH: Consensus statement on therapeutic endoscopy and bleeding ulcers. Gastrointest Endosc 36:S62–S65, 1990

    Google Scholar 

  31. Bown S: Bleeding peptic ulcers. Veni, vidi, vici per via naturalis. Br Med J 302:1417–1418, 1991

    Google Scholar 

  32. Kleiman RL, et al: Reported by: Geus WP, Lamers CBHW: Prevention of stress ulcer bleeding: A review. Scand J Gastroenterol 25(suppl 178):32–41, 1990

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Servizio di Gastroenterologia ed Endoscopia Digestiva, Divisione Medicina d'Urgenza, Servizio di Anestesia II, and Divisione IV Chirurgia, Ospedale ULSS 10, Treviso, Italy

    Silvano Loperfido MD, Fabio Monica MD, Luisa Maifreni MD, Agostino Paccagnella MD, Roberto Famà MD, Riccardo Dal Pos MD & Carlo Sartori MD

Authors
  1. Silvano Loperfido MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fabio Monica MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luisa Maifreni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agostino Paccagnella MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Famà MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Riccardo Dal Pos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlo Sartori MD
    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

Loperfido, S., Monica, F., Maifreni, L. et al. Bleeding peptic ulcer occurring in hospitalized patients. Digest Dis Sci 39, 698–705 (1994). https://doi.org/10.1007/BF02087410

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02087410

Key words

Search

Navigation