REDUCED LONG-TERM SURVIVAL FOLLOWING MAJOR PEPTIC-ULCER HEMORRHAGE

Background The late outcome of patients who present with major peptic ulcer haemorrhage is unclear. An examination was made of the hypothesi s that prognosis may be poor because many such patients have severe co -morbid diseases. Methods Some 121 patients treated endoscopically for severe peptic ulcer haemorrhage were followed for a median of 36 (ran ge 30-76) months and outcome was compared with that of age-and sex-mat ched controls. Results Thirty patients (25 per cent) died during the f ollow-up period and Kaplan-Meier plots showed reduced survival in pati ents with ulcers (P<0.01). Death was restricted largely to patients wh o had co-morbid diseases. Eight of the remaining 91 patients had furth er peptic ulcer bleeding; two of these were taking maintenance acid-re ducing therapy and only one had significant dyspepsia before rebleedin g. Eighty-three per cent of surviving patients had little or no dyspep sia. Conclusions The late prognosis of patients who present with major ulcer haemorrhage is poor, but most deaths are a consequence of co-mo rbid disease and not recurrent ulcer bleeding. Most patients have litt le dyspepsia and those who rebleed are largely free from dyspepsia.