Abstract
From October 1980 to September 1983 all patients with upper gastrointestinal bleeding were admitted to a centralised unit and investigated by early endoscopy. A total of 142 patients with a proved duodenal or gastric ulcer were randomised after stratification for age and site of ulcer to early (aggressive) surgical management or a delayed (conservative) policy. Significantly more operations (n = 42; 60%) were performed in the early than in the delayed (n = 9; 20%) groups (p less than 0.01). There were no deaths among the 42 patients under 60. The overall mortality in the 100 patients aged over 60 was 10% and when analysed on an "intention to treat" basis there was no difference between early and delayed surgery. When, however, an unrelated death from a bleeding colonic polyp was excluded and the data analysed on "treatment received" the mortality was only 2% in the early group compared with 13% in the delayed group (p less than 0.05). When analysis was confined to gastric ulcer the difference between early (0%) and delayed (24%) treatment was even greater. The results of this trial indicate that for patients over 60 an aggressive surgical policy is associated with a significant reduction in mortality.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- 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]
- Chang F. C., Drake J. E., Farha G. J. Massive upper gastrointestinal hemorrhage in the elderly. Am J Surg. 1977 Dec;134(6):721–723. doi: 10.1016/0002-9610(77)90310-5. [DOI] [PubMed] [Google Scholar]
- Dronfield M. W., Atkinson M., Langman M. J. Effect of different operation policies on mortality from bleeding peptic ulcer. Lancet. 1979 May 26;1(8126):1126–1128. doi: 10.1016/s0140-6736(79)91803-8. [DOI] [PubMed] [Google Scholar]
- FRAENKEL G. J., TRUELOVE S. C. Haematemesis, with special reference to peptic ulcer. Br Med J. 1955 Apr 23;1(4920):999–1002. doi: 10.1136/bmj.1.4920.999. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Hunt P. S., Hansky J., Korman M. G. Mortality in patients with haematemesis and melaena: a prospective study. Br Med J. 1979 May 12;1(6173):1238–1240. doi: 10.1136/bmj.1.6173.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 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]
- Palmer E. D. The vigorous diagnostic approach to upper-gastrointestinal tract hemorrhage. A 23-year prospective study of 1,4000 patients. JAMA. 1969 Feb 24;207(8):1477–1480. [PubMed] [Google Scholar]
- 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]
- Vellacott K. D., Dronfield M. W., Atkinson M., Langman M. J. Comparison of surgical and medical management of bleeding peptic ulcers. Br Med J (Clin Res Ed) 1982 Feb 20;284(6315):548–550. doi: 10.1136/bmj.284.6315.548. [DOI] [PMC free article] [PubMed] [Google Scholar]