[Upper gastrointestinal hemorrhage. Prospective analysis of 741 cases]

A prospective study was performed to evaluate the epidemiological characteristics and clinical outcome of patients with upper digestive bleeding. Between April 1987 and May 1993, 741 patients, 517 men and 224 women, with a mean age of 50.48 years (range, 12 to 94) were admitted to the emergency department with this diagnosis. The chief complaint was tarry stool (88.4%). A total of 717 patients underwent endoscopic examination within a mean time of 17.2 hours of arrival at the emergency department. Duodenal ulcers were found in 216 (35.9%) patients, gastric ulcer in 240 (32.4%), gastritis in 74 (10%), esophageal varices in 38 (5.1%), and other causes in 121 patients (16.5%). 478 required blood transfusion (range of 1 to 15 blood units transfused). 80.4% of patients who died necessitated transfusion versus 62.5% of the patients who had a satisfactory outcome. A total of 672 cases (92%) were managed with medical therapy. In 90 cases (12.2%) endoscopic injection treatment with 75% alcohol was performed. 60 patients (8.18%) had surgical therapy, 81.7% of whom underwent emergency operation to arrest bleeding. The global mortality was 10.6% (78 of 741 patients), compared to 18.3% in patients who were operated. The highest mortality occurred in patients with esophageal varices. We conclude that peptic ulcer is still the mayor cause of upper digestive bleeding. The high mortality found in patients who required surgical therapy creates the need to select those patients who may get benefits of alternate therapies which may improve the outcome.