Biphasic diurnal periodicity in bleeding from peptic ulcer.
OBJECTIVE
To evaluate if there was periodicity in the manifestations of gastrointestinal bleeding (hematemesis and melena).


METHODS
This is a multicenter prospective study carried out in the Endoscopy Units of eight hospitals. At the time of the emergency endoscopy, the following data were collected: age, sex, endoscopic diagnosis, solar hour of the first hematemesis (vomiting of bright red or tarry black material) and of the first melena (black or bloody soft stools), and any drugs taken during the week before the bleeding episode, regardless of the dose.


RESULTS
806 patients were studied. Bleeding was from peptic ulcer in 405 patients (50%), from esophageal varices in 197 (24%), and from other sources in the remainder. Analysis using single cosinor statistics showed a nonrandom distribution in bleeding from peptic ulcer, whether presenting first with hematemesis (p = 0.02) or melena (p = 0.03). There were two peaks at 6:45 AM and 6:45 PM for hematemesis and at 7:25 AM and 7:25 PM for melena, representing a biphasic diurnal (ultradian) rhythm.


CONCLUSIONS
This study shows that bleeding due to peptic ulcer has a biphasic diurnal periodicity. This has potential importance for the pathogenesis of bleeding, for the management of gastrointestinal hemorrhage and the administration of drugs known to cause peptic ulcer bleeding.
Minoli
G
G
Valduce Hospital of Como, Italy.
Terruzzi
V
V
Imperiali
G
G
Frigerio
G
G
Colombo
E
E
Comin
U
U
Corsini
G
G
Curzio
M
M
Prada
A
A
Rocca
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004384:Duodenoscopy; D005260:Female; D005773:Gastroscopy; D006396:Hematemesis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008551:Melena / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000503:physiopathology*; D010507:Periodicity; D011446:Prospective Studies