Acute gastrointestinal bleeding. Experience of a specialized management team.
The initial experience of a specialized management team organized to provide expedient care for all acute major gastrointestinal bleeding in protocolized fashion at a large referral center is presented. Of the 417 patients, 56% developed bleeding while hospitalized. Upper gastrointestinal bleeding accounted for 82%. The five most common etiologies included gastric ulcers (83 patients), duodenal ulcers (67 patients), erosions (41 patients), varices (35 patients), and diverticulosis (29 patients). Nonsteroidal anti-inflammatory drugs were implicated in 53% of gastroduodenal ulcers. The incidence of nonbleeding visible vessels was 42% in gastric and 54% in duodenal ulcers. The rates of rebleeding were 24% (20 patients) in gastric ulcers and 28% (19 patients) in duodenal ulcers. Predictive factors for rebleeding included copious bright red blood, active arterial streaming, spurting, or a densely adherent clot. The rebleeding rate for esophagogastric varices was 57%. The mortality rate overall was 6% (27 patients), with rates varying from 3% (five patients) for gastroduodenal ulcers to 40% (14 patients) for esophagogastric varices. The morbidity rate for the entire patient population was 18% (77 patients), dominated by myocardial events (34 patients). The average length of hospitalization for gastroduodenal ulcers was 5 days, for diverticulosis 8 days, and for varices 10 days. The major efforts of a specialized Gastrointestinal Bleeding Team would be best directed at both reducing the morbidity associated with acute bleeding and reducing the overall cost of care.
Gostout
C J
CJ
Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Wang
K K
KK
Ahlquist
D A
DA
Clain
J E
JE
Hughes
R W
RW
Larson
M V
MV
Petersen
B T
BT
Schroeder
K W
KW
Tremaine
W J
WJ
Viggiano
T R
TR
D000293:Adolescent; D000328:Adult; D000368:Aged; D003113:Colonoscopy; D004241:Diverticulum, Colon / Q000150:complications / Q000175:diagnosis; D004381:Duodenal Ulcer / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D012008:Recurrence; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis / Q000628:therapy