Impact of change to early diagnosis and surgery in major upper gastrointestinal bleeding

The diagnostic, operation, and mortality rates in two series of patients with major upper gastrointestinal bleeding have been compared. In one (1968-69) patients were admitted to medical wards, radiology was the only investigation, and few were operated on. In 1972-74 a more vigorous policy was adopted with investigation by both radiology and endoscopy, more (and earlier) surgery, and intensive care by a surgical team. Failure to reach a diagnosis fell from 38-9% to 5-7%; the operation-rate increased; transfusion requirements decreased; and mortality in both operated (47% v. 11%) and non-operated (17% v. 8%) fell. A policy of early and vigorous investigation and management by a surgical team is urged for patients presenting with severe bleeding from the duodenum, stomach, or oesophagus.