[Prospective study of diagnosis, therapy and follow-up of acute gastrointestinal hemorrhage in 397 patients].
The mortality of acute GI hemorrhage in the literature varies considerably, depending on the study design and quality of the data evaluated. We therefore conducted a prospective study over 2.5 years of 397 patients with suspected acute GI hemorrhage at the University hospital of Erlangen for internal quality control. In 99% of cases diagnostic endoscopy identified one or more bleeding sources. 46% of the patients bled from duodenal or gastric ulcers, 21% from esophageal or gastric varices and 33% from other sources. 228 of the 397 patients (57%) were initially treated endoscopically, 76 patients (19%) experienced a recurrence of bleeding. Patients older than 60 years of age with a hemoglobin below 8 g/dl had a significantly higher rate of recurrent bleeding. The rate of complications during the hospital stay was 22% (n = 87), in-hospital mortality 17% (n = 68). The rates of recurrent bleeding (28 vs. 20%), complications (24 vs. 18%) and mortality (20 vs. 14%) were significantly higher for bleeding varices than for peptic ulcers. Patients with other causes of acute GI hemorrhage developed a recurrence of bleeding in 13%, complications in 26% and had a mortality rate of 19%. Bleeding varices as well as bleeding peptic ulcers and other causes of acute GI hemorrhage still have a high mortality and require intensive medical surveillance besides diagnostic and therapeutic endoscopy.
Dertinger
S H
SH
Abteilung Innere Medizin, Landeskrankenhaus Feldkirch/Vorarlberg, Bundesrepublik Deutschland.
Vestner
H
H
Müller
K
K
Merz
M
M
Hahn
E G
EG
Altendorf-Hofmann
A
A
Ell
C
C
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D011446:Prospective Studies; D015911:Sclerotherapy; D015996:Survival Rate
D000897:Anti-Ulcer Agents
Prospektive Untersuchung zu Diagnostik, Therapie und Verlauf der akuten gastrointestinalen Blutung bei 397 Patienten.