title: Prospective evaluation of immediate versus delayed refeeding and prognostic value of endoscopy in patients with upper gastrointestinal hemorrhage.
abstract: The effects of immediate vs. delayed refeeding and the prognostic value of endoscopic findings in patients with major upper gastrointestinal hemorrhage were assessed in a prospective randomized study. Entry criteria were clinical evidence of major hemorrhage and endoscopic evidence of a Mallory-Weiss tear or an ulcer with a clean base, flat spot, or clot. Two hundred fifty-eight patients were randomly assigned to groups receiving a regular diet immediately or nothing by mouth for 36 hours, then clear liquids for 12 hours, and a regular diet thereafter. Outcomes in the immediate and delayed refeeding groups were comparable: rebleeding occurred in 4% vs. 5%; urgent intervention, 2% vs. 2%; and deaths, 1% vs. 1%, respectively. Rebleeding occurred in 2 (2%) of 96 patients with cleanbased ulcers, 5 (8%) of 65 with ulcers with spots, 3 (14%) of 21 with ulcers with clots (P = 0.05, 3 x 2 chi2 test), and 1 (2%) of 66 with Mallory-Weiss tears. It is concluded that the time of refeeding does not influence the hospital course of patients with a low risk of recurrent bleeding. Patients with clean-based ulcers or nonbleeding Mallory-Weiss tears may be refed and discharged home immediately after stabilization.
authors.affiliation: Department of Medicine, University of Southern California School of Medicine, Los Angeles.
authors.forename: L
authors.initials: L
authors.lastname: Laine
authors.forename: H
authors.initials: H
authors.lastname: Cohen
authors.forename: J
authors.initials: J
authors.lastname: Brodhead
authors.forename: D
authors.initials: D
authors.lastname: Cantor
authors.forename: F
authors.initials: F
authors.lastname: Garcia
authors.forename: M
authors.initials: M
authors.lastname: Mosquera
mesh_terms: D004724:Endoscopy; D005502:Food; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors