title: Etiology and course of acute bleeding esophageal ulcers.
abstract: Twenty (2%) of 1,140 patients with acute gastrointestinal bleeding had esophageal ulcers. Patients with esophageal ulcers most commonly had either melena (40%) or melena and hematemesis (40%). Fifty percent had orthostatic hypotension, and 80% required transfusions. Ulcers were associated with nonsteroidal anti-inflammatory drugs (NSAIDs) use in 50%, hiatal hernia in 60%, and esophagitis in 40%. Endoscopic stigmata of recent hemorrhage consisted of oozing blood (35%) and adherent clot (25%). Six patients had multiple ulcers. The majority of ulcers (90%) were in the distal esophagus. Nine patients were endoscopically treated without complications except for rebleeding in 1 patient. Endoscopic therapy was associated with decreased duration of hospitalization. Overall mortality was 45% in these patients, but no deaths were related to bleeding. Although uncommon, esophageal ulcers are a cause of significant acute gastrointestinal bleeding that appears to respond to endoscopic treatment.
authors.affiliation: Division of Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
authors.forename: H C
authors.initials: HC
authors.lastname: Wolfsen
authors.forename: K K
authors.initials: KK
authors.lastname: Wang
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001471:Barrett Esophagus / Q000150:complications; D004935:Esophageal Diseases / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D004941:Esophagitis / Q000150:complications; D004945:Esophagoscopy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D014456:Ulcer / Q000209:etiology / Q000401:mortality / Q000628:therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal