Stigmata of hemorrhage in bleeding ulcers

Models for predicting rebleeding after upper GI bleeding, and practice guidelines to determine management of these patients, must include not only endoscopic findings but clinical variables, such as severity of blood loss and the age and comorbidity of the patient. The importance of these variables in determining rebleeding risk, and the high degree of interobserver variability in identifying stigmata of hemorrhage, suggest that management strategies based too heavily on stigmata result in inappropriate discharge of some patients. The validity of various management strategies incorporating stigmata of hemorrhage needs to be prospectively assessed.