Abstract
To evaluate risk factors for peptic ulcer bleeding, prospective data from 261 patients treated with a defined therapeutic policy (early elective operation in high-risk patients) at two Surgical University Departments between 1982 and 1985, and 1987 and 1991 were analysed. In a multivariate analysis, statistically significant prognostic factors for rebleeding were: early elective operation (p<0.001), bleeding activity (p<0.001), age (p<0.02), and haematemesis (p < 0.05). Multivariate analysis of mortality revealed rebleeding during hospital stay (p< 0.001), number of concomitant diseases (p<0.01), number of blood transfusion units (p<0.02), and bleeding activity at emergency endoscopy (p<0.02) as the major prognostic factors. The defined treatment policy resulted in low rebleeding and death rates in the high-risk group (arterial bleeding, visible vessel). However, in the subgroup with oozing bleeding and signs of recent bleeding (suspected better prognosis), recurrent haemorrhage and high mortality (35%) were observed. From this study, we conclude that the major determinants of a fatal outcome in bleeding peptic ulcer disease are recurrent bleeding, and the physiological reserve of the patient together with a minor bleeding activity (oozing bleeding, signs of recent bleeding). New therapeutic regimens for these subgroups are recommended.
Published Version
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