Outcomes of bleeding peptic ulcers: A prospective study

Nai Jen Liu, Ching Song Lee, Jui-Hsiang Tang, Hao Tsai Cheng, Yin Yi Chu, Kai Feng Sung, Cheng Hui Lin, Yung Kuan Tsou, Jau Min Lien, Pang Chi Chen, Cheng Tang Chiu, Chi Liang Cheng

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Abstract

Background and Aim: Bleeding peptic ulcers can be due to Helicobacter pylori (H. pylori) infection, use of non-steroidal anti-inflammatory drugs (NSAIDs), or idiopathic causes. The aim of this prospective study was to identify the clinical outcomes of bleeding peptic ulcers related to different causes. Methods: A total of 390 patients with bleeding ulcers were evaluated consecutively between June 2005 and August 2006. The diagnosis of H. pylori infection was made at index endoscopy, using histology and the rapid urease test. If both endoscopic diagnostic tests were not performed, a serological test was applied to detect the presence of H. pylori infection in a previously untreated patient. The prevalence and outcome of bleeding ulcers are related to H. pylori infection, NSAID use, and non-H. pylori idiopathic causes. The outcome between patients who were admitted for ulcer bleeding (outpatient bleeder) and those who bled while hospitalized (in-hospital bleeder) was also compared. Results: NSAID ulcers were noted in 223 patients, H. pylori ulcers in 102, and non-H. pylori idiopathic ulcers in 65. In total, 298 patients had outpatient bleeders, and 92 had in-hospital bleeders. The overall 3-day rebleeding rate was 11.8% and the mortality rate was 5.4%. Eighteen of the 21 mortality cases died of their underlying comorbid illness. Patients with non-H. pylori idiopathic ulcers had a significantly higher mortality rate than NSAID and H. pylori ulcers (12.3% vs 4.5% vs 2.9%, P = 0.02). Patients with H. pylori ulcers had significantly favorable outcomes than patients with NSAID ulcers (less blood transfusion and a shorter hospital stay) and non-H. pylori idiopathic ulcers (shorter hospital stay and a lower mortality). Patients with in-hospital bleeders had an adverse outcome as compared to outpatient bleeders, including a 3-day rebleeding rate (25.0% vs 7.7%, P < 0.0001), 30-day rebleeding rate (32.6% vs 12.1%, P < 0.0001), and higher mortality rate (16.3% vs 2.0%, P < 0.0001). Conclusion: This study emphasizes the role of non-H. pylori idiopathic ulcers and in-hospital bleeders as the determining high-risk predictors for bleeding peptic ulcers.

Original languageEnglish
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume23
Issue number8 PART2
DOIs
Publication statusPublished - Jan 1 2008
Externally publishedYes

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Keywords

  • Helicobacter pylori
  • Non-steroidal anti-inflammatory drugs
  • Outcome
  • Ulcer bleeding

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Liu, N. J., Lee, C. S., Tang, J-H., Cheng, H. T., Chu, Y. Y., Sung, K. F., Lin, C. H., Tsou, Y. K., Lien, J. M., Chen, P. C., Chiu, C. T., & Cheng, C. L. (2008). Outcomes of bleeding peptic ulcers: A prospective study. Journal of Gastroenterology and Hepatology (Australia), 23(8 PART2). https://doi.org/10.1111/j.1440-1746.2007.05179.x