Late outcome of bleeding gastric ulcer. Five to eight years' follow-up.
BACKGROUND
Gastric ulcer haemorrhage is associated with a high immediate mortality, but few data exist on the late prognosis of these patients. The aim of this study was to determine the long-term recurrence rate and late outcome in patients with gastric ulcer complicated with bleeding.


METHODS
In a prospective follow-up study 90 consecutive patients with a bleeding gastric ulcer discharged after non-operative treatment (bleeding controlled by endoscopic electrocoagulation or ceased spontaneously) were followed up once every year for 5-8 years (median, 6.5 years).


RESULTS
Recurrent ulcer was seen in 17 patients, repeat haemorrhage being the presenting symptom in 13 of them. The estimated cumulative recurrence rate after 2, 5, and 8 years was 10%, 19% and 33%, respectively. Recurrence rate was unaffected by sex, complicating disease, and non-steroidal anti-inflammatory drugs (NSAIDs) ingestion before and after the index bleeding episode. The recurrence rate of patients with a history of ulcer before the index bleeding episode did not differ from that of patients with no previous ulcer history. A significantly increased risk of recurrence was seen in patients with previous bleed as opposed to patients with previous non-bleeding ulcer (p < 0.05). The cumulative survival rate was significantly reduced compared with the expected survival rate of the sex- and age-matched background population (p < 0.01), primarily because of diseases not related to the ulcer disease.


CONCLUSIONS
Bleeding gastric ulcer is associated with a relatively low long-term recurrence rate, except in a few patients with a history of previous bleeding ulcer, who have an increased risk of recurrence. Patients with bleeding gastric ulcer have an excess mortality not related to the ulcer disease.
Rørbaek-Madsen
M
M
Surgical Gastroenterological Dept., Aarhus University Hospital, Denmark.
Fischer
L
L
Thomsen
H
H
Wara
P
P
D000368:Aged; D002927:Cimetidine / Q000627:therapeutic use; D004564:Electrocoagulation; D005260:Female; D005500:Follow-Up Studies; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D015996:Survival Rate; D013997:Time Factors
D002927:Cimetidine