Document Detail


Initial factors predicting rebleeding and death in bleeding peptic ulcer disease.
MedLine Citation:
PMID:  15138534     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Bleeding peptic ulcer constitutes approximately half of the cases admitted with upper gastrointestinal bleeding. Although the bleeding episode stops spontaneously in most of them, rebleeding occurs in as much as 10-30% of them and has a mortality rate of 5-10%. In this study, we have evaluated the possible significant predictors associated with this adverse outcome. METHODS: The records of 205 patients admitted to gastrointestinal bleeding unit (GIBU) in Riyadh Central Hospital, during the period May 1996 through to April 1999, with endoscopic confirmed diagnosis of bleeding peptic ulcer disease were reviewed for demography, clinical presentation, hematology, biochemistry, initial blood pressure, nasogastric lavage color, co-morbid disease and endoscopic findings. All the significant factors found initially (P<0.05) were entered into odds ratio and its 95% confidence interval and finally the unconditioned logistic regression model was used to find out the significant independent predictors for both rebleeding and mortality in these patients. RESULTS: The majority of patients (85%) were males and below the age of 60 (73%). Duodenal ulcer was the source of bleeding in 84%. Endoscopy was performed in all patients within 24 hours of admission. Only 15% were actively bleeding at the time of initial endoscopy. Thirty-six patients (17%) rebelled, majority within 72 hours of initial hemostasis. Overall, 11 patients (5%) died, 6 of them were rebleeders. Initial presentation of systolic blood pressure <100 mm Hg, blood in nasogastric tube and visible vessel within the ulcer in endoscopy were independent predictors of rebleeding while initial systolic blood pressure <100 mm Hg and age >60-years were independent predictors of mortality. CONCLUSION: Improvement of outcome in patients with bleeding peptic ulcer disease can be achieved by early detection of those patients who are at risk of adverse outcome. Patients with the above mentioned independent predictors of rebleeding and mortality are best managed in the intensive care unit with endoscopic hemostasis and proton pump inhibitor (PPI) therapy for a minimum of 5-days of admission.
Authors:
Mohammed H Al-Akeely; Mohammed K Alam; Saleh M Al-Salamah; Mahmood A Abdu; Ibrahim N Al-Teimi; Abdulmajeed A Mohammed
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Saudi medical journal     Volume:  25     ISSN:  0379-5284     ISO Abbreviation:  Saudi Med J     Publication Date:  2004 May 
Date Detail:
Created Date:  2004-05-12     Completed Date:  2004-09-28     Revised Date:  2008-06-23    
Medline Journal Info:
Nlm Unique ID:  7909441     Medline TA:  Saudi Med J     Country:  Saudi Arabia    
Other Details:
Languages:  eng     Pagination:  642-7     Citation Subset:  IM    
Affiliation:
Department of General Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cause of Death
Female
Humans
Male
Middle Aged
Peptic Ulcer Hemorrhage / mortality*
Recurrence
Risk
Saudi Arabia
Survival Analysis

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