Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 Oct;212(4):521–527. doi: 10.1097/00000658-199010000-00014

Upper GI bleeding in an urban hospital. Etiology, recurrence, and prognosis.

C Sugawa 1, C P Steffes 1, R Nakamura 1, J J Sferra 1, C S Sferra 1, Y Sugimura 1, D Fromm 1
PMCID: PMC1358290  PMID: 2222017

Abstract

Acute upper gastrointestinal bleeding (UGIB) continues to be a common cause of hospital admission and morbidity and mortality. This study reviews 469 patients admitted to a surgical service of an urban hospital. There were 562 total admissions because 53 patients were readmitted 93 times (recurrence rate, 20%). The most common causes of bleeding, all endoscopically diagnosed, included acute gastric mucosal lesion (AGML) (135 patients, 24%), esophageal varices (EV) (121 patients, 22%), gastric ulcer (108 patients, 19%), duodenal ulcer (78 patients, 14%), Mallory-Weiss tear (61 patients, 11%), and esophagitis (15 patients, 3%). Nonoperative therapy was sufficient in 504 cases (89.5%). Endoscopic treatment was used in 144 cases. Operations were performed in 58 cases (10.5%), including 29% of ulcers. Emergency operations to control hemorrhage were required in only 2.5% of all cases. The rate of major surgical complications was 11% and the mortality rate was 5.2%. There were 58 deaths (12.6%), with 36 deaths directly attributable to UGIB. Factors correlating with death include shock at admission (systolic blood pressure less than 80), transfusion requirement of more than five units, and presence of EV (all p less than 0.001). Most cases of UGIB can be treated without operation, including endoscopic treatment, when diagnostic endoscopy establishes the source. Subsequent operation in selected patients can be done with low morbidity and mortality rates.

Full text

PDF
524

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bornman P. C., Theodorou N. A., Shuttleworth R. D., Essel H. P., Marks I. N. Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation. Br Med J (Clin Res Ed) 1985 Jul 27;291(6490):245–247. doi: 10.1136/bmj.291.6490.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bumaschny E., Doglio G., Pusajó J., Vetere L., Parra C., Grosso R. M., Schieppati E. Postoperative acute gastrointestinal tract hemorrhage and multiple-organ failure. Arch Surg. 1988 Jun;123(6):722–726. doi: 10.1001/archsurg.1988.01400300068011. [DOI] [PubMed] [Google Scholar]
  3. Clason A. E., Macleod D. A., Elton R. A. Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage. Br J Surg. 1986 Dec;73(12):985–987. doi: 10.1002/bjs.1800731213. [DOI] [PubMed] [Google Scholar]
  4. Cutler J. A., Mendeloff A. I. Upper gastrointestinal bleeding. Nature and magnitude of the problem in the U.S. Dig Dis Sci. 1981 Jul;26(7 Suppl):90S–96S. doi: 10.1007/BF01300814. [DOI] [PubMed] [Google Scholar]
  5. Dagradi A. E., Ruiz R. A., Weingarten Z. G. Influence of emergency endoscopy on the management and outcome of patients with upper gastrointestinal hemorrhage. Analysis of 500 cases. Am J Gastroenterol. 1979 Oct;72(4):403–415. [PubMed] [Google Scholar]
  6. Devitt J. E., Brown F. N., Beattie W. G. Fatal bleeding ulcer. Ann Surg. 1966 Nov;164(5):840–844. doi: 10.1097/00000658-196611000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dronfield M. W., Langman M. J., Atkinson M., Balfour T. W., Bell G. D., Vellacott K. D., Amar S. S., Knapp D. R. Outcome of endoscopy and barium radiography for acute upper gastrointestinal bleeding: controlled trial in 1037 patients. Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):545–548. doi: 10.1136/bmj.284.6315.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Elerding S. C., Moore E. E., Wolz J. R., Norton L. W. Outcome of operations for upper gastrointestinal tract bleeding. Arch Surg. 1980 Dec;115(12):1473–1477. doi: 10.1001/archsurg.1980.01380120041010. [DOI] [PubMed] [Google Scholar]
  9. Fleischer D. Etiology and prevalence of severe persistent upper gastrointestinal bleeding. Gastroenterology. 1983 Mar;84(3):538–543. [PubMed] [Google Scholar]
  10. Foster D. N., Miloszewski K. J., Losowsky M. S. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J. 1978 May 6;1(6121):1173–1177. doi: 10.1136/bmj.1.6121.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Fromm D. Endoscopic coagulation for gastrointestinal bleeding. N Engl J Med. 1987 Jun 25;316(26):1652–1654. doi: 10.1056/NEJM198706253162608. [DOI] [PubMed] [Google Scholar]
  12. Gendler S. L., Faisal M. A., Holt P. R. Evaluation of primary and secondary gastrointestinal bleeders. Arch Intern Med. 1989 Jul;149(7):1634–1636. [PubMed] [Google Scholar]
  13. Gilbert D. A., Silverstein F. E., Tedesco F. J., Buenger N. K., Persing J. The national ASGE survey on upper gastrointestinal bleeding. III. Endoscopy in upper gastrointestinal bleeding. Gastrointest Endosc. 1981 May;27(2):94–102. doi: 10.1016/s0016-5107(81)73157-2. [DOI] [PubMed] [Google Scholar]
  14. Gostout C. J. Acute gastrointestinal bleeding--a common problem revisited. Mayo Clin Proc. 1988 Jun;63(6):596–604. doi: 10.1016/s0025-6196(12)64890-3. [DOI] [PubMed] [Google Scholar]
  15. Greenburg A. G., Saik R. P., Bell R. H., Collins G. M. Changing patterns of gastrointestinal bleeding. Arch Surg. 1985 Mar;120(3):341–344. doi: 10.1001/archsurg.1985.01390270079013. [DOI] [PubMed] [Google Scholar]
  16. Griffiths W. J., Neumann D. A., Welsh J. D. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med. 1979 Jun 21;300(25):1411–1413. doi: 10.1056/NEJM197906213002503. [DOI] [PubMed] [Google Scholar]
  17. Hellers G., Ihre T. Impact of change to early diagnosis and surgery in major upper gastrointestinal bleeding. Lancet. 1975 Dec 20;2(7947):1250–1251. doi: 10.1016/s0140-6736(75)92085-1. [DOI] [PubMed] [Google Scholar]
  18. Himal H. S., Perrault C., Mzabi R. Upper gastrointestinal hemorrhage: aggressive management decreases mortality. Surgery. 1978 Oct;84(4):448–454. [PubMed] [Google Scholar]
  19. Katschinski B. D., Logan R. F., Davies J., Langman M. J. Audit of mortality in upper gastrointestinal bleeding. Postgrad Med J. 1989 Dec;65(770):913–917. doi: 10.1136/pgmj.65.770.913. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Katz D., Pitchumoni C. S., Thomas E., Antonelle M. The endoscopic diagnosis of upper-gastrointestinal hemorrhage. Changing concepts of etiology and management. Am J Dig Dis. 1976 Feb;21(2):182–189. doi: 10.1007/BF01072066. [DOI] [PubMed] [Google Scholar]
  21. Kim B., Wright H. K., Bordan D., Fielding L. P., Swaney R. Risks of surgery for upper gastrointestinal hemorrhage: 1972 versus 1982. Am J Surg. 1985 Apr;149(4):474–476. doi: 10.1016/s0002-9610(85)80042-8. [DOI] [PubMed] [Google Scholar]
  22. Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med. 1987 Jun 25;316(26):1613–1617. doi: 10.1056/NEJM198706253162601. [DOI] [PubMed] [Google Scholar]
  23. Larson D. E., Farnell M. B. Upper gastrointestinal hemorrhage. Mayo Clin Proc. 1983 Jun;58(6):371–387. [PubMed] [Google Scholar]
  24. Larson G., Schmidt T., Gott J., Bond S., O'Connor C. A., Richardson J. D. Upper gastrointestinal bleeding: predictors of outcome. Surgery. 1986 Oct;100(4):765–773. [PubMed] [Google Scholar]
  25. Laurence B. H., Cotton P. B. Bleeding gastroduodenal ulcers: nonoperative treatment. World J Surg. 1987 Jun;11(3):295–303. doi: 10.1007/BF01658106. [DOI] [PubMed] [Google Scholar]
  26. Lyons S. D., Sugawa C., Geller E. R., Vandenberg D. M. Comparison of 1% sodium tetradecyl sulfate to a thrombogenic sclerosant cocktail for endoscopic sclerotherapy. Am Surg. 1988 Feb;54(2):81–84. [PubMed] [Google Scholar]
  27. Matthews J. B., Tortella B. J., Silen W. Gastroduodenal hemorrhage and perforation in the postoperative period. Surg Gynecol Obstet. 1988 Nov;167(5):389–392. [PubMed] [Google Scholar]
  28. Read R. C., Huebl H. C., Thal A. P. Randomized study of massive bleeding from peptic ulceration. Ann Surg. 1965 Oct;162(4):561–577. doi: 10.1097/00000658-196510000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Schrock T. R. Does endoscopy affect the surgical approach to the patient with upper gastrointestinal bleeding? Dig Dis Sci. 1981 Jul;26(7 Suppl):27S–30S. doi: 10.1007/BF01300803. [DOI] [PubMed] [Google Scholar]
  30. Silverstein F. E., Gilbert D. A., Tedesco F. J., Buenger N. K., Persing J. The national ASGE survey on upper gastrointestinal bleeding. II. Clinical prognostic factors. Gastrointest Endosc. 1981 May;27(2):80–93. doi: 10.1016/s0016-5107(81)73156-0. [DOI] [PubMed] [Google Scholar]
  31. Sugawa C. Endoscopic diagnosis and treatment of upper gastrointestinal bleeding. Surg Clin North Am. 1989 Dec;69(6):1167–1183. doi: 10.1016/s0039-6109(16)44982-0. [DOI] [PubMed] [Google Scholar]
  32. Sugawa C., Werner M. H., Hayes D. F., Lucas C. E., Walt A. J. Early endoscopy. A guide to therapy for acute hemorrhage in the upper gastrointestinal tract. Arch Surg. 1973 Aug;107(2):133–137. doi: 10.1001/archsurg.1973.01350200007004. [DOI] [PubMed] [Google Scholar]
  33. Villar H. V., Roberts Fender H., Watson L. C., Thompson J. C. Emergency diagnosis of upper gastrointestinal bleeding by fiberoptic endoscopy. Ann Surg. 1977 Mar;185(3):367–374. doi: 10.1097/00000658-197703000-00019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Wara P. Incidence, diagnosis, and natural course of upper gastrointestinal hemorrhage. Prognostic value of clinical factors and endoscopy. Scand J Gastroenterol Suppl. 1987;137:26–27. doi: 10.3109/00365528709089757. [DOI] [PubMed] [Google Scholar]
  35. de Dombal F. T., Clarke J. R., Clamp S. E., Malizia G., Kotwal M. R., Morgan A. G. Prognostic factors in upper G.I. bleeding. Endoscopy. 1986 May;18 (Suppl 2):6–10. doi: 10.1055/s-2007-1018418. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES