Peptic ulcer hemorrhage: factors predisposing to recurrence.
Two hundred and eighty patients with stigmata of recent or active bleeding from a peptic ulcer were followed up after endoscopic or conservative medical treatment. Of the patients 53% had no history of dyspeptic symptoms, but 17% and 10% had a history of uncomplicated ulcer or bleeding ulcer, respectively, before the index admission. After 8 years of follow-up the estimated recurrence rate was 29% (95% confidence limits, 12-47%). At recurrence 65% of the patients presented with a rebleed and 12% with a perforation. By means of a logistic regression analysis, a previous history of ulcer haemorrhage was identified as the only predictor associated with a significantly increased risk of recurrence. The recurrence rate in 253 patients presenting with a first bleed at the index admission was 23%, compared with 73% in 27 patients with a history of bleeding before the index admission (p = 0.001). The rate of recurrence was not influenced by a history of previous uncomplicated ulcer disease or dyspeptic symptoms, the severity of the index bleed, the methods of management of the index bleed, age, use of non-steroidal anti-inflammatory drugs, or long-term treatment with cimetidine.
Dept. of Surgical Gastroenterology, Aarhus Kommunehospital, Denmark.
I
I
Fischer
M R
MR
Madsen
H
H
Thomsen
V
V
Høst
P
P
Wara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004415:Dyspepsia / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000503:physiopathology*; D010439:Peptic Ulcer Perforation / Q000150:complications; D012008:Recurrence; D012044:Regression Analysis