Related Experiment Videos
[Clinical and endoscopic prognostic factors in patients with bleeding peptic ulcer]
Javier P Gisbert1, Ignacio Llorca, José Cantero
1Servicio de Aparato Digestivo. Hospital Universitario de la Princesa. Madrid. Spain.
Insights
This study identified key clinical and endoscopic factors that predict the outcome of upper gastrointestinal bleeding (UGB). Applying these factors could help safely discharge more patients with peptic gastroduodenal lesions.
Area of Science:
- Gastroenterology
- Internal Medicine
Context:
- Upper gastrointestinal bleeding (UGB) from peptic gastroduodenal lesions requires careful management.
- Identifying prognostic indicators is crucial for optimizing patient care and resource allocation.
Purpose:
- To review clinical and endoscopic variables in patients with UGB due to peptic gastroduodenal lesions.
- To identify characteristics associated with negative UGB outcomes.
- To analyze characteristics of patients discharged immediately post-endoscopy.
Summary:
- A retrospective analysis of 156 UGB patients revealed duodenal ulcer (52%) and gastric ulcer (30%) as common causes.
- Negative UGB evolution (7%) was linked to older age, red hematemesis, hypotension, tachycardia, and severe endoscopic findings (Forrest classification).
- Immediate discharge was possible for 11% of patients; applying predictive variables could have avoided hospitalization in 38% without complications.
Impact:
- Identified easily applicable clinical and endoscopic variables (presentation, blood pressure, heart rate, Forrest classification) for precise UGB prognosis.
- Enables reliable identification of a significant number of UGB patients suitable for ambulatory management.
- Potential to reduce unnecessary hospitalizations and improve healthcare efficiency for UGB patients.
Background:
The main objectives of this study were to review the clinic and endoscopic variables of patients with upper gastrointestinal bleeding (UGB) due to peptic gastroduodenal lesions who were evaluated in our hospital during one year, to identify the characteristics associated with a negative evolution of the UGB and to analyse the characteristics of those patients who were discharged immediately after the endoscopy was performed.
Patients And Method:
A one-year retrospective analysis of all UGB episodes was performed. Patients having gastroduodenal ulcer or erosive gastritis/duodenitis at endoscopy were included. The prognostic value of several clinic, laboratory and endoscopic variables was evaluated. Persistence or recurrence of bleeding, surgery and mortality were considered as outcome variables (the variable evolution was categorized as negative when any of these was observed).
Results:
156 patients were identified, with a mean (SD) age of 61 (17) years. Melena was the most frequent UGB presentation (79%). 46% patients had associated diseases and 50% were taking gastroerosive drugs. Duodenal ulcer was the commonest cause of UGB (52%), followed by gastric ulcer (30%). The evolution of UGB was negative in 7% cases. Variables associated with a negative evolution in the multivariate analysis were: age, red hematemesis, systolic blood pressure >= 100 mmHg, heart rate >= 100 b.p.m. and a more severe Forrest endoscopic classification. 11% patients were discharged immediately, without complications afterwards. If predictive variables obtained in the multivariate analysis would have been applied, hospitalization would have been avoided in 59 patients (38%) without subsequent complications.
Conclusions:
A number of clinic and endoscopic variables (UGB presentation form, blood pressure, heart rate, and Forrest endoscopic classification) with prognostic value have been identified in this study. These variables are easy to obtain and apply in clinical practice, allowing a precise estimate of the UGB evolution. Thus, a relatively high number of patients with UGB susceptible of ambulatory treatment and management can be reliably identified.