title: The prognosis of patients having received optimal therapy for nonvariceal upper gastrointestinal bleeding might be worse in daily practice than in randomized clinical trials.
abstract: BACKGROUND
  Combination of endoscopic haemostatic and high-dose intravenous proton-pump inhibitors is considered to be the standard care for patients with acute peptic ulcer bleeding.
  
  
  OBJECTIVE
  This study assessed predictive factors of rebleeding and death in unselected patients presented to our hospital.
  
  
  METHODS
  Consecutive patients with nonmalignant bleeding ulcers and stigmata of recent haemorrhage who received optimal treatment, between 22 August 2003 and 15 October 2007, were studied retrospectively.
  
  
  RESULTS
  Among 140 included patients, 45 (32%) rebled and 30 received another haemostatic endoscopy, which was successful in 20 cases. In multivariate analysis, the only significant predictive factor of rebleeding was duodenal site of the ulcer [adjusted odds ratio (OR): 2.75; 95% confidence interval (CI): 1.28-6.19]. In-hospital death occurred in 27 (19%) patients; with five deaths related to uncontrolled or recurrent bleeding. In multivariate analysis, predictors of in-hospital mortality were rebleeding (adjusted OR: 3.28; 95% CI: 1.17-9.16), a Rockall score higher than 6 (adjusted OR: 9.12; 95% CI: 2.57-44.29) and bleeding occurring in the intensive care unit (adjusted OR: 15.68; 95% CI: 4.41-55.82).
  
  
  CONCLUSIONS
  In unselected patients, rebleeding and mortality rates are substantially higher than those found in prospective randomized clinical trials. Intensive care unit stay is an important predictive factor of hospital mortality and should be considered in further therapeutic trials in ulcer bleeding.
authors.affiliation: Department of Gastroenterology and Nutrition, Jean Minjoz University Hospital, Besançon, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Fein
authors.forename: Audrey
authors.initials: A
authors.lastname: Weber
authors.forename: Stéphane
authors.initials: S
authors.lastname: Koch
authors.forename: Nicolas
authors.initials: N
authors.lastname: Festou
authors.forename: Anne Claire
authors.initials: AC
authors.lastname: Dupont-Gossard
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Cervoni
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Monnet
authors.forename: Marc
authors.initials: M
authors.lastname: Bardou
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D005260:Female; D005602:France / Q000453:epidemiology; D016558:Hemostasis, Endoscopic / Q000009:adverse effects; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D000077402:Pantoprazole; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality / Q000628:therapy*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole