Evaluation of risk factors in mortality among our peptic ulcer bleeding patients in 2005

Introduction: Endoscopic diagnosis and treatment of upper gastrointestinal bleeding is one of the most difficult tasks for gastroenterologist's. The most common bleeding sources are benign peptic gastric and duodenal ulcer, corresponding 40–50% of the upper gastrointestinal bleeding patients.

Methods: The aim of this retrospective study was to define risk factors of mortality in patients referred for emergency endoscopy for upper gastrointestinal bleeding.

Results: 292 patients were examined in our endoscopical department because of hematemesis and/or melena during 2005. Emergency endoscopy detected gastric or duodenal ulcer as a bleeding source in 134 patients (45.9%). The gastric vs. duodenal ulcer ratio was 58 vs. 76 pts. The mean age was 67.1 +/- 12.6 year; the female/male ratio was 53/81. Application of the Forrest staging to assess of the severity of the bleeding, high proportion of the patients (63.4%) belonged to the high risk groups (Forrest I-II/a). Helicobacter pylori was present in 40.4% of tested cases. Endoscopic treatment was performed in 72.4% of patients. Rebleeding rate was 12.3%, overall mortality rate was 10.4% (14 from 134 pts).

Higher mean age (75.1 vs. 66.1 year), on admission lower mean hemoglobin level (8.2 vs. 9.2g/dl) and hematocrit (0.25 vs. 0.28) was found in non-survivors than in survivors. Ulcerogen drug consumption (92.8% vs. 64.1%) and severe co-morbidity (100% vs. 60%) occurred more frequently in patients dying in hospital. Initial hemodinamical instability (64.2 vs.42.5%) and higher rebleeding rate (28.5 vs. 5.0%) were significant risk factors for hospital mortality.

Conclusion: Our results demonstrated that elderly peptic ulcer bleeding patients with significant co-morbidity and ulcerogen drug consumption are at risk of lethal outcome.