title: Giant peptic ulcer hemorrhages: epidemiology, treatment, and outcome in the teaching hospital of Tartu.
abstract: The aim of the study was to analyze the management and outcome in the case of giant peptic ulcer hemorrhage (GPUH).
  
  
  METHODS
  We analyzed the data of all 372 cases of 348 patients treated for acute peptic ulcer hemorrhage during 2005-2007. The source and intensity of hemorrhage was assessed endoscopically according to the Forrest classification: class I+II, persistent hemorrhage or signs of recent hemorrhage; and class III, ulcer without signs of recent hemorrhage. Of the 372 cases, 64 (17%) were GPUH (diameter, ≥2 cm) (group 1) and the remaining 308 (83%) were peptic ulcer hemorrhages of a standard size (SPUH) (diameter, <2 cm), which formed the control group (group 2).
  
  
  RESULTS
  Forrest class I+II hemorrhage occurred significantly more frequently in the group 1 as compared with the group 2 (97% [62/64] vs. 77% [238/308]), as well as endoscopic hemostasis, (80% [51/64] vs. 57% [175/308]), repeat hemostasis procedures (22% [11/51] vs 6.3% [11/175]), and operative treatment (27.6% [16/58] vs 1.7% [5/290]) were needed more frequently in the group 1. No postoperative in-hospital deaths occurred in either group. Five patients died: 2 (3.4% [2/58]) in the group 1 and 3 (1.0% [3/290]) in the group 2.
  
  
  CONCLUSIONS
  GPUHs were more intensive as compared with SPUHs and needed more endoscopic hemostasis, including repeat procedures and operative treatment. Endoscopic hemostasis and operative treatment allowed reducing mortality due to GPUH to 3.4%.
authors.affiliation: Department of Surgery, Tartu University, L. Puusepa 8, 51014 Tartu, Estonia. ants.peetsalu@kliinikum.ee
authors.forename: Ants
authors.initials: A
authors.lastname: Peetsalu
authors.forename: Ulle
authors.initials: U
authors.lastname: Kirsimägi
authors.forename: Margot
authors.initials: M
authors.lastname: Peetsalu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004957:Estonia / Q000453:epidemiology; D005260:Female; D016558:Hemostasis, Endoscopic; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome