Endoscopy 2018; 50(04): S6
DOI: 10.1055/s-0038-1637040
ESGE Days 2018 oral presentations
20.04.2018 – GI bleeding
Georg Thieme Verlag KG Stuttgart · New York

PREDICTIVE FACTORS FOR REBLEEDING IN PATIENTS WITH PEPTIC ULCER BLEEDING

V Rednic
1   Regional Institute of Gastroenterology-Hepatology ‘Prof.Dr. Octavian Fodor’, Cluj-Napoca, Romania
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
S Pasca
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
I Groza
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
C Coada
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
A Orban
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
M Tantau
1   Regional Institute of Gastroenterology-Hepatology ‘Prof.Dr. Octavian Fodor’, Cluj-Napoca, Romania
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
,
D Matei
1   Regional Institute of Gastroenterology-Hepatology ‘Prof.Dr. Octavian Fodor’, Cluj-Napoca, Romania
2   Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

The aim of the study was to identify factors that influence rebleeding rate in patients with peptic ulcer bleeding (PUB)

Methods:

In the present study we included all patients presenting to the emergency department of a tertiary care center with PUB throughout an 18-month period (January 2015-June 2016). The following factors that could influence the rebleeding rate were followed:

  • Demographic data (age, sex)

  • Hypotension (SBP< 90 mmHg) upon arrival

  • Tachycardia (HR> 100bpm) upon arrival

  • Smoking

  • Alcohol consumption (> 50 g alcohol/day)

  • Use of antiplatelets, anticoagulants or NSAIDs

  • Externalization of UGI bleeding: hematemesis, melena, hematochezia

  • Endoscopic Forrest classification: IA,IB,IIA,2B defined as “high-risk stigmata” and IIC,III defined as “low-risk stigmata”

  • Rockall score for upper GI bleeding

All patients have undergone upper GI endoscopy and were followed for 30 days for rebleeding.

Results:

In the present study, 431 patients were included. The mean age was 63.3 years (min 16 years, max 94 years) with a majority of men (69.1%). 48 patients (11.1%) suffered another bleeding episode during the follow-up. Demographic data, hemodynamic status upon arrival, smoking or alcohol consumption, use of drugs or Rockall classification had no significant influence on the rate of rebleeding. Rebleeding rate was higher in patients presenting with hematemesis (16.4% vs. 6%, p < 0.01) and hematochezia (40% vs. 10.5%, p < 0.05), but not in those presenting with melena. Patients having high-risk stigmata on upper GI endoscopy had a higher risk of rebleeding (14.2% vs. 5.7%, p < 0.05). These three factors were also independently associated with rebleeding: hematemesis (HR = 3.13, 95% CI: 1.55 – 6.31, p < 0.05), hematochezia (HR = 8.83, 95% CI: 2.16 – 36.12, p < 0.01) and high-risk stigmata (HR = 2.43,95% CI: 1.12 – 5.28, p < 0.05).

Conclusions:

The rebleeding rate was 11.1%.

Hematemesis, hematochezia and high risk stigmata on upper GI endoscopy are significantly associated with rebleeding in patients with PUB. Patients presenting with hematochezia have the highest risk of rebleeding