We have adopted a uniform, aggressive approach to the management of up
per gastrointestinal hemorrhage. our protocol consists of admission to
a surgical service, endoscopy within 24 hours, and liberal use of int
ensive care monitoring. Urgent or emergency surgery is recommended for
the following criteria: 1) presence of shock upon admission, 2) resus
citation requirements of greater than 4 units of blood; 3) age 65 year
s or older; 4) ulcer size greater than 2 cm or with stigmata of recent
hemorrhage; or 5) history of a previous admission for an ulcer compli
cation. During the period 1986-1990, 66 patients met the criteria for
operation. There were 45 males and 21 females with an average age of 5
3.5 years (range, 29-84). Thirty-seven bled from a gastric ulcer and 2
9 from a duodenal ulcer. They were transfused an average of 5.0 units
of blood (range, 0-13). There were no hospital deaths, but 11 patients
(16.7%) had 12 postoperative complications. We conclude that a unifie
d, single team approach to gastroduodenal hemorrhage with expedited wo
rk-up and early operation prevents death from this treatable condition
.