Rebleeding rate of various stigmata of recent hemorrhage in peptic ulcer bleeding with different severity.
The stigmata of recent hemorrhage (SRH) have been used as a factor for predicting peptic ulcer rebleeding. In previous studies, the rebleeding rate of the visible vessel varied. A hypothesis had been proposed stating that the evolution of the color of the stigmata depends on the point in the healing process of the blood clot on the bleeding ulcer. This retrospective study evaluates the rebleeding rates associated with various colors of stigmata of recent hemorrhage. Of a total of 623 cases of peptic ulcer bleeding (474 male and 149 female, with a mean age of 59 years old), there were 232 gastric ulcers, 369 duodenal ulcers, and 22 stomal ulcers. Stigmata of recent hemorrhage were found in 387 cases (62%). The overall rebleeding rate for those with gastric ulcers was higher than for those with duodenal ulcers (24.2% versus 16.3%, p<0.05), especially for oozing and sentinel clots, the rebleeding rates for active bleeding, blood clots, sentinel clots, and others were 35%, 24.8%, 17%, and 11.3% respectively. The red clot of stigmata of recent hemorrhage had a slightly higher rebleeding rate than the black clot, but the difference was not statistically important. Furthermore, the 5 duodenal ulcers with white sentinel clots experienced no rebleeding. When comparing the rebleeding rates between groups with massive and minor bleeding, a significantly higher rebleeding rate was found in the massive bleeding group (50.5% versus 6.6%, p < 0.001). It can thus be seen that the different types of stigmata of recent hemorrhage represent different stages in the healing process of a bleeding ulcer. A white sentinel clot had a change of not rebleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
Chen
J J
JJ
Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC.
Changchien
C S
CS
Lee
C M
CM
Hu
T H
TH
Hsiaw
C M
CM
Chen
C L
CL
Leu
C Y
CY
Hsu
C C
CC
Lin
C C
CC
D016009:Chi-Square Distribution; D005260:Female; D005773:Gastroscopy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis*; D012008:Recurrence; D012189:Retrospective Studies