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Characteristics and outcomes of gastroduodenal ulcer bleeding: a single-centre experience in Lithuania
Pavel Petrik1, Saulė Brašiškienė2, Eglė Petrik3
1Clinic of Gastroenterology, Nephro-Urology and Surgery, Centre of General Surgery, Vilnius University, Faculty of Medicine, Vilnius, Lithuania.
Insights
Peptic ulcer bleeding (PUB) management requires focus beyond haemostasis. Elderly patients (≥65 years) face increased mortality risk, highlighting the need to address non-bleeding causes in PUB treatment strategies.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Peptic ulcer bleeding (PUB) mortality remains high despite optimal endoscopic and pharmacologic treatments.
- A significant proportion of PUB deaths are attributed to non-bleeding-related complications.
Purpose of the Study:
- To analyze gastroduodenal ulcer bleeding management focusing on age, gender, comorbidities, and drug use.
- To evaluate the impact of these factors on PUB patient characteristics and outcomes.
Main Methods:
- Retrospective review of medical records for patients with gastroduodenal ulcer hemorrhage from 2008-2012.
- Analysis of patient demographics, comorbidities, medication history, and clinical outcomes.
Main Results:
- 219 patients identified; 46.6% were elderly (≥65 years).
- Elderly patients showed a significantly increased risk of mortality (RR = 2.21, p=0.021).
- Younger patients had higher rates of duodenal ulcers and liver failure; medication use was more common in gastric ulcer patients.
Conclusions:
- PUB management should prioritize reducing multiorgan failure and cardiopulmonary death.
- Focusing solely on haemostasis is insufficient for improving overall patient survival in peptic ulcer bleeding.
Introduction:
Despite the optimal use of combined endoscopic haemostasis and pharmacologic control of acid secretion in the stomach, mortality in patients with peptic ulcer bleeding (PUB) has remained constant. Recent data has shown that the majority of patients with PUB die of non-bleeding-related causes.
Aim:
To provide an overview of our experience of PUB management, with emphasis on the effect of age, gender, comorbidities, and drug use on the characteristics and outcomes of gastroduodenal ulcer bleeding.
Material And Methods:
We retrospectively reviewed the medical records of all patients admitted with the primary diagnosis of acute, chronic or unspecified gastric and/or duodenal ulcer with haemorrhage during 2008-2012.
Results:
Two hundred and nineteen patients were identified. 46.6% of patients were ≥ 65 years old (elderly) and 53.4% were < 65 years old (young). The young patients were more likely to have duodenal ulcers and liver failure at admission. Previous use of medications was more regularly observed in gastric ulcer patients than in duodenal ulcer patients. Rebleeding occurred in 43 (19.6%) patients and death in 5 (2.3%) patients. Increased risk of mortality in our patients was associated with age ≥ 65 years (RR = 2.21; 95% CI: 1.90-2.56; p = 0.021).
Conclusions:
Management of peptic ulcer bleeding should aim at reducing the risk of multiorgan failure and cardiopulmonary death instead of focusing merely on successful haemostasis.
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