Treatment and prognosis in peptic ulcer bleeding

Area of Science:

• Gastroenterology and Hepatology
• Interventional Radiology
• Clinical Epidemiology

Background:

• Peptic ulcer bleeding (PUB) is a common cause of hospital admission with persistent high 30-day mortality.
• Risk scoring systems can identify low-risk patients for outpatient management, but their routine implementation in Denmark is limited due to external validity concerns.
• Transcatheter arterial embolization (TAE) is increasingly used for refractory PUB, and its supplementary role after endoscopic therapy warrants investigation.
• The long-term mortality associated with PUB and the impact of blood transfusions require further examination.

Purpose of the Study:

• To evaluate the efficacy of different risk scoring systems in predicting hospital intervention, rebleeding, and mortality in upper gastrointestinal bleeding.
• To assess whether supplementary transcatheter arterial embolization (STAE) improves outcomes in patients with peptic ulcer bleeding following successful endoscopic hemostasis.
• To investigate the short- and long-term mortality in peptic ulcer bleeding patients compared to a matched control group, identifying predictors of mortality and the role of blood transfusion.

Main Methods:

• Study I: Prospective validation of risk scoring systems (including Glasgow Blatchford Score) in 831 patients with upper gastrointestinal hemorrhage.
• Study II: Non-blinded, randomized controlled trial (105 patients) comparing supplementary TAE (STAE) with standard treatment after endoscopic hemostasis.
• Study III: Prospective cohort study comparing long-term mortality of 455 PUB patients with 2224 matched controls, adjusting for comorbidity.

Main Results:

• The Glasgow Blatchford Score (GBS) was superior in predicting the need for hospital-based intervention and showed potential for cost savings.
• None of the risk scoring systems reliably predicted rebleeding or 30-day mortality.
• STAE demonstrated a trend towards reduced rebleeding rates (NNT=10).
• Peptic ulcer bleeding was associated with excess long-term mortality, with age, comorbidity, sex, anemia, and tobacco use as key predictors.
• Comorbidity was the primary driver of 30-day mortality, while blood transfusion was not directly associated with long-term mortality.

Conclusions:

• The Glasgow Blatchford Score is recommended for assessing Danish patients with upper gastrointestinal bleeding to optimize resource allocation.
• Supplementary TAE may reduce rebleeding in peptic ulcer bleeding patients after endoscopic therapy.
• Peptic ulcer bleeding significantly increases long-term mortality, underscoring the importance of managing comorbidities and risk factors.