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Treatment and outcome of gastrointestinal bleeding due to peptic ulcers and erosions - (BLUE study)
Katrine Kauczynska Romstad1,2, Trond Espen Detlie2,3, Taran Søberg1
1Department of Gastroenterology, Østfold Hospital Trust, Grålum, Norway.
Insights
This study shows endoscopic hemostasis is effective for peptic ulcers and erosions, but rebleeding remains a challenge, particularly for duodenal ulcers. Management strategies aim to improve outcomes for upper gastrointestinal bleeding patients.
Area of Science:
- Gastroenterology
- Endoscopy
- Hepatology
Background:
- Peptic ulcers and erosions are primary causes of upper gastrointestinal bleeding.
- Effective management is crucial for patient outcomes.
Purpose of the Study:
- To investigate the management and outcomes of patients with bleeding peptic ulcers and erosions.
- To identify factors influencing rebleeding and treatment success.
Main Methods:
- A cohort of 543 patients with endoscopically confirmed bleeding ulcers/erosions was studied.
- Data collected included patient characteristics, endoscopic findings (Forrest classification), and treatments.
- Rebleeding rates, need for repeat procedures, and surgical interventions were recorded, with follow-up endoscopy.
Main Results:
- High-risk stigmata ulcers were found in 36% of patients; low-risk in 60%.
- Endoscopic therapy achieved hemostasis in 94% of treated patients (155/165).
- Overall rebleeding was 9%, but higher (14.8%) after successful endoscopic treatment. Duodenal ulcers showed higher rebleeding rates (11.9%) than gastric ulcers (4.0%). Rebleeding correlated with comorbidity and Forrest classification. Angiographic embolization and surgery were infrequent (6% and 0.07%).
Conclusions:
- Endoscopic hemostasis is successful for most high-risk ulcerations.
- Rebleeding presents a significant challenge, especially in duodenal ulcer cases.
- Complete ulcer healing was observed in 73.3% of patients at follow-up.
Objectives:
Peptic ulcers and erosions are the most common causes of upper gastrointestinal bleeding. The aim of this study was to investigate the management and outcomes of these patients.
Materials And Methods:
A total of 543 patients with endoscopically confirmed bleeding from peptic ulcers and erosions were included from March 2015 to December 2017. The patient characteristics, endoscopic findings, Forrest classification and endoscopic treatment were recorded. Moreover, the rebleeding rates, repeated endoscopies and transcatheter angiographic embolization and surgery incidences were registered. A follow-up endoscopy after discharge from the hospital was scheduled.
Results:
Among the patients, high-risk stigmata ulcers were present in 36% (198/543) and low-risk stigmata ulcers and erosions in 60% (327/543) at first endoscopy. Endoscopic therapy was performed in 30% (165/543) of the patients, and hemostasis was achieved in 94% (155/165). The incidence of rebleeding was 9% (49/543) for the whole cohort and 14.8% (23/155) for those patients who had received successful endoscopic treatment. Moreover, rebleeding was significantly more frequent in duodenal ulcers than in gastric ulcers (11.9% vs 4.0%, p = .004). In a multivariable analysis, rebleeding was significantly related to comorbidity and Forrest classification. Transcatheter angiographic embolization and surgery were required in 6% (34/543) and 0.07% (4/543) of patients, respectively. Complete peptic ulcer healing was found at follow-up in 73.3% (270/368) of patients.
Conclusions:
Endoscopic hemostasis was achieved in the majority of patients with high-risk ulceration, although the occurrence of rebleeding is a significant challenge, especially in patients with duodenal ulcers. Clinical trial registration: Bleeding Ulcer and Erosions Study (BLUE Study), ClinicalTrials.gov identifier: NCT03367897.
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