title: Acute upper gastrointestinal bleeding in operated stomach: outcome of 105 cases.
abstract: OBJECTIVE
  To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.
  
  
  METHODS
  The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.
  
  
  RESULTS
  Patients who underwent gastric surgery in the past were older (mean age: 68.1+/-11.7 years vs 62.8+/-17.8 years, P = 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding, compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P = 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past (9/73 (12.3%) vs 19/360 (5.3%), P = 0.025). Moreover surgically treated patients in the past required more blood transfusion (3.3+/-4.0 vs 1.5+/-1.7, P = 0.0001) and longer hospitalization time (8.6+/-4.0 vs 6.9+/-4.9 d, P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups (4/105 (3.8%) vs 19/608 (3.1%)).
  
  
  CONCLUSIONS
  Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University Hospital, Patras, Greece. bnikolop@med.upatras.gr
authors.forename: Vassiliki-N
authors.initials: VN
authors.lastname: Nikolopoulou
authors.forename: Konstantinos-C
authors.initials: KC
authors.lastname: Thomopoulos
authors.forename: George-I
authors.initials: GI
authors.lastname: Theocharis
authors.forename: Vassiliki-A
authors.initials: VA
authors.lastname: Arvaniti
authors.forename: Constantine-E
authors.initials: CE
authors.lastname: Vagianos
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000706:statistics & numerical data*; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D013276:Stomach Ulcer / Q000453:epidemiology* / Q000601:surgery*