Natural History of Upper Gastrointestinal Bleeding and Determinants of Outcome

Abstract

Prior to a discussion of endoscopic hemostatic therapy, an overview of the spectrum of upper gastrointestinal (UGI) hemorrhage is appropriate with emphasis on its natural history and the various factors affecting its outcome. UGI bleeding remains a common and serious problem. It is estimated there are 100,000 admissions each year in the United States due to UGI bleeding from peptic ulcer disease alone (1). Overall, the mortality rate for UGI bleeding is approximately 8% to 10% (2–4). For those patients who continue to bleed after hospital admission or rebleed while in the hospital, the mortality rate increases to 20% (2, 3, 5). If urgent surgery is required for uncontrolled bleeding, the mortality increases further to approximately 25% (2–5). In contrast, if bleeding is controlled and then elective surgery is performed, the expected mortality rate falls to less than 3% (6, 7).