title: Impact of change to early diagnosis and surgery in major upper gastrointestinal bleeding.
abstract: The diagnostic, operation, and mortality rates in two series of patients with major upper gastrointestinal bleeding have been compared. In one (1968-69) patients were admitted to medical wards, radiology was the only investigation, and few were operated on. In 1972-74 a more vigorous policy was adopted with investigation by both radiology and endoscopy, more (and earlier) surgery, and intensive care by a surgical team. Failure to reach a diagnosis fell from 38-9% to 5-7%; the operation-rate increased; transfusion requirements decreased; and mortality in both operated (47% v. 11%) and non-operated (17% v. 8%) fell. A policy of early and vigorous investigation and management by a surgical team is urged for patients presenting with severe bleeding from the duodenum, stomach, or oesophagus.
mesh_terms: D003949:Diagnostic Techniques, Surgical; D004724:Endoscopy; D004945:Esophagoscopy; D005336:Fiber Optic Technology; D005767:Gastrointestinal Diseases / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D005773:Gastroscopy; D013997:Time Factors