title: Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.
abstract: BACKGROUND
  We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis.
  
  
  OBJECTIVE
  We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis.
  
  
  METHODS
  We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions.
  
  
  RESULTS
  Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p < 0.0001), while melena was less common in patients with esophagitis 38% (45/119) than in controls 68% (244/357) (p < 0.0001). Additionally, the more severe the esophagitis, the more frequent was melena. Patients with esophagitis had less abnormal vital signs, lesser decreases in hematocrit, and lesser increases in BUN. Both pre- and postRockall scores were lower in patients with esophagitis compared with controls (p = 0.01, and p < 0.0001, respectively). Length of hospital stay (p = 0.002), rebleeding rate at 42 days (p = 0.0007), and mortality were less in patients with esophagitis than controls. Finally, analysis of patients with esophagitis and cirrhosis suggested that this group of patients had more severe bleeding than those without cirrhosis.
  
  
  CONCLUSIONS
  We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.
authors.affiliation: Division of Digestive and Liver Diseases, Department of Internal Medicine, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Prathima
authors.initials: P
authors.lastname: Guntipalli
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chason
authors.forename: Alan
authors.initials: A
authors.lastname: Elliott
authors.forename: Don C
authors.initials: DC
authors.lastname: Rockey
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004941:Esophagitis / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D041742:Upper Gastrointestinal Tract / Q000473:pathology*