AN 8 YEAR EXPERIENCE WITH UPPER GASTROINTESTINAL-BLEEDING - DIAGNOSIS, TREATMENT AND PROGNOSIS

Bleeding from the upper gastrointestinal tract is one of the most comm on medical emergencies. Admission of patients to a specialized care un it may reduce morbidity and mortality. All patients admitted to the Te l Aviv Medical Center, between January 1, 1983 and December 31, 1990 w ith acute upper gastrointestinal bleeding, or those who bled while in the hospital, were seen and assessed by a senior member of the gastroi ntestinal service. Endoscopy was performed within 24 hr of admission. A total of 1110 endoscopies were performed. Duodenal ulcer was the mai n source of bleeding (40.0%). Injection of a vasoconstrictor was used for very small blood vessels. Thermal methods were used for small or m edium sized vessels, or for oozing from a margin ulcer; both with equa l rates of success. 153 (13.8%) surgical procedures were performed. Th ree (0.37) patients had endoscopic cardiovascular complications; one o f them died. The in-hospital mortality was 5.9%. Increasing age, other medical problems, rebleeding and an admission hemoglobin of 8 g/dL or less, were associated with increased mortality. Our policy of early c linical and endoscopic assessment, and rapid surgical intervention in those at high risk, markedly improved survival.