ACUTE GASTRO–INTESTINAL HÆMORRHAGE PROGNOSTIC FACTORS ON A CONSERVATIVE REGIME

Abstract

An analysis of a consecutive series of 1,634 unselected patients admitted to hospital for acute gastro-duodenal haemorrhage, with particular reference to prognostic factors, is presented. Two-thirds of the patients were admitted to hospital for chronic peptic ulcer; one-quarter of them were considered to have acute lesions. The management of the patients was based upon the conservative use of blood transfusion, early feeding, liberal sedation and avoidance of surgery. The overall mortality rate was 11.0%, and that for peptic ulcer, 8.5%. Analysis of the clinical and pathological data on the deaths showed that, at most, 2.4% of all the patients, or 4% of patients suffering from ulcer haemorrhages, had the potential to be helped by surgery. These did not fulfil the usual criteria for surgery. On this regime, a good prognosis was associated with acute lesions, bleeding after isolated aspirin intake or previously definitive ulcer surgery, with duodenal ulcer in those aged under 50 years, and bleeding from the ulcer in employed males aged less than 60 years. A poor prognosis was associated with gastric ulcer, even in young patients, with regular aspirin intake, a history of dyspepsia of less than one year and when the provisional diagnosis was incorrect. Advancing age and concurrent disease had a similar effect. It is considered that, if one uses the regime outlined, prompt recourse to surgery, regardless of the age of the patient, should be restricted to the small group of patients who bleed again after the establishment of such treatment, who have chronic gastric ulcer and who are shown not to be bleeding from acute erosion, especially in patients who are regular takers of aspirin.