[Outpatient care of upper gastrointestinal hemorrhage not related to portal hypertension].
BACKGROUND
The handling of upper gastrointestinal hemorrhage (UGH) usually includes the hospitalization of all patients, regardless of severity and prognosis. The aim of this paper is to assess the security of the outpatient control of some UGH, after their assessment in the hospital emergency room.


METHODS
Prospective cohort of 533 patients who attended over 1994 and 1995 hospital emergency room for an episode of UGH not linked to portal hypertension. After clinical and endoscopical assessment in the emergency department, 422 cases (79%) were admitted and 111 (21%) discharged for outpatient care. An analysis is presented of the characteristics of both groups, their clinical outcomes and a multivariate analysis to assess the factors associated with the decision to admit the patient.


RESULTS
Outpatients were young, with less comorbidity and better haemodynamic status than hospitalized patients. Most of outpatient cases UGH was due to gastroduodenitis, oesophagitis and Mallory-Weiss syndrome, as opposed to the greater importance of peptic ulcer in those admitted. All outpatients presented clean lesions or haematic remains. 25 (5.9%) hospitalized patients presented rebleeding, vs. only 1 (0.9%) outpatient (p < 0.05). When more severity cases were excluded from hospital group, the differences were not significant. All cases with active bleeding, severe haemodynamic repercussion or without endoscopy were admitted. For the remainder, the decision to admit was associated with the presence of bleeding stigmata, haemodynamic repercussion, some causes of hemorrhage, older age, and urea levels.


CONCLUSIONS
Although the scarce sample do not permit definitive conclusions, results guide towards that a substantial part of UGH not linked to portal hypertension may be monitored without hospitalizing the patient, thereby minimizing care costs and increasing the productive capacity of the hospital, without increasing risks for the patient.
Servicio de Gastroenterología, Hospital Clínico-Universitario, Universidad de Valencia.
P
P
Almela
A
A
Benages
S
S
Peiró
F
F
Grau
M
M
Mínguez
A
A
Peña
I
I
Pascual
F
F
Mora
D000553:Ambulatory Care / Q000592:standards*; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000534:rehabilitation*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain