Skip to main content
NCBI home page
Journal of the Royal Society of Medicine logoLink to Journal of the Royal Society of Medicine
. 1980 Feb;73(2):90–95.

Survey of management in acute upper gastrointestinal haemorrhage1

G E Thomas, P B Cotton, C G Clark, P B Boulos
PMCID: PMC1437337  PMID: 6971943

Abstract

The answers to a questionnaire concerning attitudes of members of the British Society of Gastroenterology to the management of acute upper gastrointestinal bleeding are analysed. In the majority of cases patients were admitted to general wards under the care of physicians. Use of intensive therapy units and venous pressure monitoring varied widely. Emergency endoscopy appeared readily available and was usually the first diagnostic procedure. Double contrast radiology and emergency angiography were available in relatively few centres. Specific nonoperative treatments (angiographic and endoscopic) were scarcely employed. Most respondents agreed that elderly patients fared badly, but there was little agreement concerning other factors which influence re-bleeding or outcome. There was a wide divergence of opinion concerning the need for surgical intervention in certain hypothetical clinical situations. Despite the difficulties involved, we believe that controlled trials are necessary to improve the management of bleeding patients.

Full text

PDF
90

Selected References

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

  1. Allan R., Dykes P. A study of the factors influencing mortality rates from gastrointestinal haemorrhage. Q J Med. 1976 Oct;45(180):533–550. [PubMed] [Google Scholar]
  2. Allen H. M., Block M. A., Schuman B. M. Gastroduodenal endoscopy. Management of acute upper gastrointestinal hemorrhage. Arch Surg. 1973 Apr;106(4):450–455. doi: 10.1001/archsurg.1973.01350160068011. [DOI] [PubMed] [Google Scholar]
  3. Athanasoulis C. A., Waltman A. C., Novelline R. A., Krudy A. G., Sniderman K. W. Angiography: its contribution to the emergency management of gastrointestinal hemorrhage. Radiol Clin North Am. 1976 Aug;14(2):265–280. [PubMed] [Google Scholar]
  4. BARON J. H., CONNELL A. M., KANAGHINIS T. G., LENNARD-JONES J. E., JONES A. F. Out-patient treatment of ulcerative colitis. Comparison between three doses of oral prednisone. Br Med J. 1962 Aug 18;2(5302):441–443. doi: 10.1136/bmj.2.5302.441. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Butler M. L., Johnson L. F., Clark R. Diagnostic accuracy of fiberoptic panendoscopy and visceral angiography in acute upper gastrointestinal bleeding. Am J Gastroenterol. 1976 Jun;65(6):501–511. [PubMed] [Google Scholar]
  6. COGHILL N. F., WILLOCX R. G. Factors in the prognosis of bleeding chronic gastric and duodenal ulcers. Q J Med. 1960 Oct;29:575–596. [PubMed] [Google Scholar]
  7. Clark C. G. Surgical aspects of gastro-intestinal haemorrhage. Postgrad Med J. 1968 Aug;44(514):590–593. doi: 10.1136/pgmj.44.514.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cocks J. R., Desmond A. M., Swynnerton B. F., Tanner N. C. Partial gastrectomy for haemorrhage. Gut. 1972 May;13(5):331–340. doi: 10.1136/gut.13.5.331. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Crook J. N., Gray L. W., Jr, Nance F. C., Cohn I., Jr Upper gastrointestinal bleeding. Ann Surg. 1972 May;175(5):771–782. doi: 10.1097/00000658-197205000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Devitt J. E. Upper gastrointestinal bleeding with special reference to peptic ulcer. Gastroenterology. 1969 Jul;57(1):89–94. [PubMed] [Google Scholar]
  11. Dronfield M. W., McIllmurray M. B., Ferguson R., Atkinson M., Langman M. J. A prospective, randomised study of endoscopy and radiology in acute upper-gastrointestinal-tract bleeding. Lancet. 1977 Jun 4;1(8023):1167–1169. doi: 10.1016/s0140-6736(77)92713-1. [DOI] [PubMed] [Google Scholar]
  12. Eastwood G. L. Does early endoscopy benefit the patient with active upper gastrointestinal bleeding? Gastroenterology. 1977 Apr;72(4 Pt 1):737–739. [PubMed] [Google Scholar]
  13. 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]
  14. Hegarty M. M., Grime R. T., Schofield P. F. The management of upper gastro-intestinal tract haemorrhage. Br J Surg. 1973 Apr;60(4):275–279. doi: 10.1002/bjs.1800600406. [DOI] [PubMed] [Google Scholar]
  15. Heideman M., Larsson I., Stenquist B., Zederfeldt B., Darle N. Surgical management of gastroduodenal haemorrhage. Acta Chir Scand. 1977;143(5):307–312. [PubMed] [Google Scholar]
  16. 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]
  17. Irving J. D., Northfield T. C. Emergency arteriography in acute gastrointestinal bleeding. Br Med J. 1976 Apr 17;1(6015):929–931. doi: 10.1136/bmj.1.6015.929. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. JONES F. A. Hematemesis and melena; with special reference to causation and to the factors influencing the mortality from bleeding peptic ulcers. Gastroenterology. 1956 Feb;30(2):166–190. [PubMed] [Google Scholar]
  19. Jensen H. E., Amdrup E., Christiansen P., Fenger C., Lindskov J., Nielsen J., Nielsen S. A. Bleeding gastric ulcer. Surgical and non-surgical treatment of 225 patients. Scand J Gastroenterol. 1972;7(6):535–540. doi: 10.3109/00365527209180952. [DOI] [PubMed] [Google Scholar]
  20. Johnston S. J., Jones P. F., Kyle J., Needham C. D. Epidemiology and course of gastrointestinal haemorrhage in North-east Scotland. Br Med J. 1973 Sep 29;3(5882):655–660. doi: 10.1136/bmj.3.5882.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Jones P. F., Johnston S. J., McEwan A. B., Kyle J., Needham C. D. Further haemorrhage after admission to hospital for gastrointestinal haemorrhage. Br Med J. 1973 Sep 29;3(5882):660–664. doi: 10.1136/bmj.3.5882.660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Katon R. M. Experimental control of gastrointestinal hemorrhage via the endoscope: a new era dawns. Gastroenterology. 1976 Feb;70(2):272–277. [PubMed] [Google Scholar]
  23. Kim U., Dreiling D. A., Kark A. E., Rudick J. Factors influencing mortality in surgical treatment for massive gastroduodenal hemorrhage. Am J Gastroenterol. 1974 Jul;62(1):24–35. [PubMed] [Google Scholar]
  24. LEWIN D. C., TRUELOVE S. Haematemesis, with special reference to chronic peptic ulcer. Br Med J. 1949 Mar 5;1(4600):383–386. doi: 10.1136/bmj.1.4600.383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Laufer I., Mullens J. E., Hamilton J. The diagnostic accuracy of barium studies of the stomach and duodenum--correlation with endoscopy. Radiology. 1975 Jun;115(3):569–573. doi: 10.1148/15.3.569. [DOI] [PubMed] [Google Scholar]
  26. Morgan A. G., McAdam W. A., Walmsley G. L., Jessop A., Horrocks J. C., de Dombal F. T. Clinical findings, early endoscopy, and multivariate analysis in patients bleeding from the upper gastrointestinal tract. Br Med J. 1977 Jul 23;2(6081):237–240. doi: 10.1136/bmj.2.6081.237. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Northfield T. C. Factors predisposing to recurrent haemorrhage after acute gastrointestinal bleeding. Br Med J. 1971 Jan 2;1(5739):26–28. doi: 10.1136/bmj.1.5739.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Northfield T. C., Smith T. Central venous pressure in clinical management of acute gastrointestinal bleeding. Lancet. 1970 Sep 19;2(7673):584–586. doi: 10.1016/s0140-6736(70)90166-2. [DOI] [PubMed] [Google Scholar]
  29. Schiller K. F., Truelove S. C., Williams D. G. Haematemesis and melaena, with special reference to factors influencing the outcome. Br Med J. 1970 Apr 4;2(5700):7–14. doi: 10.1136/bmj.2.5700.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Scott-Harden W. G. Radiology of acute upper digestive tract bleeding. J R Coll Physicians Lond. 1974 Jul;8(4):365–374. [PMC free article] [PubMed] [Google Scholar]
  31. Stevenson G. W., Cox R. R., Roberts C. J. Prospective comparison of double-contrast barium meal examination and fibreoptic endoscopy in acute upper gastrointestinal haemorrhage. Br Med J. 1976 Sep 25;2(6038):723–724. doi: 10.1136/bmj.2.6038.723. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. WARD-McQUAID J. N., PEASE J. C., McEWEN SMITH A., TWORT R. J. Surgery in bleeding peptic ulcers. Gut. 1960 Sep;1:258–265. doi: 10.1136/gut.1.3.258. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Walls W. D., Glanville J. N., Chandler G. N. Early investigation of haematemesis and melaena. Lancet. 1971 Aug 21;2(7721):387–390. doi: 10.1016/s0140-6736(71)90110-3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press

RESOURCES