title: Outcomes of bleeding peptic ulcers: a prospective study.
abstract: OBJECTIVE
  Bleeding peptic ulcers can be due to Helicobacter pylori (H. pylori) infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or idiopathic causes. The aim of this prospective study was to identify the clinical outcomes of bleeding peptic ulcers related to different causes.
  
  
  METHODS
  A total of 390 patients with bleeding ulcers were evaluated consecutively between June 2005 and August 2006. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. If both endoscopic diagnostic tests were not performed, a serological test was applied to detect the presence of H. pylori infection in a previously untreated patient. The prevalence and outcome of bleeding ulcers are related to H. pylori infection, NSAID use, and non-H. pylori idiopathic causes. The outcome between patients who were admitted for ulcer bleeding (outpatient bleeder) and those who bled while hospitalized (in-hospital bleeder) was also compared.
  
  
  RESULTS
  NSAID ulcers were noted in 223 patients, H. pylori ulcers in 102, and non-H. pylori idiopathic ulcers in 65. In total, 298 patients had outpatient bleeders, and 92 had in-hospital bleeders. The overall 3-day rebleeding rate was 11.8% and the mortality rate was 5.4%. Eighteen of the 21 mortality cases died of their underlying comorbid illness. Patients with non-H. pylori idiopathic ulcers had a significantly higher mortality rate than NSAID and H. pylori ulcers (12.3% vs 4.5% vs 2.9%, P = 0.02). Patients with H. pylori ulcers had significantly favorable outcomes than patients with NSAID ulcers (less blood transfusion and a shorter hospital stay) and non-H. pylori idiopathic ulcers (shorter hospital stay and a lower mortality). Patients with in-hospital bleeders had an adverse outcome as compared to outpatient bleeders, including a 3-day rebleeding rate (25.0% vs 7.7%, P < 0.0001), 30-day rebleeding rate (32.6% vs 12.1%, P < 0.0001), and higher mortality rate (16.3% vs 2.0%, P < 0.0001).
  
  
  CONCLUSIONS
  This study emphasizes the role of non-H. pylori idiopathic ulcers and in-hospital bleeders as the determining high-risk predictors for bleeding peptic ulcers.
authors.affiliation: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Liu
authors.forename: Ching-Song
authors.initials: CS
authors.lastname: Lee
authors.forename: Jui-Hsiang
authors.initials: JH
authors.lastname: Tang
authors.forename: Hao-Tsai
authors.initials: HT
authors.lastname: Cheng
authors.forename: Yin-Yi
authors.initials: YY
authors.lastname: Chu
authors.forename: Kai-Feng
authors.initials: KF
authors.lastname: Sung
authors.forename: Cheng-Hui
authors.initials: CH
authors.lastname: Lin
authors.forename: Yung-Kuan
authors.initials: YK
authors.lastname: Tsou
authors.forename: Jau-Min
authors.initials: JM
authors.lastname: Lien
authors.forename: Pang-Chi
authors.initials: PC
authors.lastname: Chen
authors.forename: Cheng-Tang
authors.initials: CT
authors.lastname: Chiu
authors.forename: Chi-Liang
authors.initials: CL
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology; D016480:Helicobacter pylori; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal