title: Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.
abstract: BACKGROUND
  Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality.
  
  
  OBJECTIVE
  To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB).
  
  
  METHODS
  Secondary analysis of prospectively collected data from 3 national databases.
  
  
  METHODS
  Community and teaching hospitals.
  
  
  METHODS
  Consecutive patients admitted for acute nonvariceal UGIB.
  
  
  METHODS
  Early endoscopy, medical and endoscopic treatment as appropriate.
  
  
  METHODS
  Thirty-day mortality, recurrent bleeding, and need for surgery.
  
  
  RESULTS
  A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P < .0001). Gastric or duodenal ulcer significantly increased the risk of death, but this was not related to the presence of high-risk stigmata (P = .368). The strongest predictor of mortality for all causes of nonvariceal UGIB was the overall physical status of the patient measured with the American Society of Anesthesiologists score (1-2 vs 3-4, P < .001).
  
  
  CONCLUSIONS
  No data on the American Society of Anesthesiologists class score in the Prometeo study.
  
  
  CONCLUSIONS
  Nonulcer causes of nonvariceal UGIB have a risk of death, similar to bleeding peptic ulcers in the clinical context of a high-risk patient.
authors: Division of Gastroenterology, Hospital Curto, Polla, Italy.
authors: Riccardo
authors: R
authors: Marmo
authors: Mario
authors: M
authors: Del Piano
authors: Gianluca
authors: G
authors: Rotondano
authors: Maurizio
authors: M
authors: Koch
authors: Maria Antonia
authors: MA
authors: Bianco
authors: Alessandro
authors: A
authors: Zambelli
authors: Giovanni
authors: G
authors: Di Matteo
authors: Enzo
authors: E
authors: Grossi
authors: Livio
authors: L
authors: Cipolletta
authors: Prometeo Investigators
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000473:pathology; D016001:Confidence Intervals; D004381:Duodenal Ulcer / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000150:complications / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D005770:Gastrointestinal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D041981:Gastrointestinal Tract / Q000098:blood supply*; D006304:Health Status; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008309:Mallory-Weiss Syndrome / Q000150:complications / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000401:mortality* / Q000601:surgery; D012008:Recurrence; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications / Q000401:mortality* / Q000601:surgery