PEPTIC-ULCER HEMORRHAGE - FACTORS PREDISPOSING TO RECURRENCE

Two hundred and eighty patients with stigmata of recent or active blee ding from a peptic ulcer were followed up after endoscopic or conserva tive medical treatment. Of the patients 53% had no history of dyspepti c symptoms, but 17% and 10% had a history of uncomplicated ulcer or bl eeding ulcer, respectively, before the index admission. After 8 years of follow-up the estimated recurrence rate was 29% (95% confidence lim its, 12-47%). At recurrence 65% of the patients presented with a reble ed and 12% with a perforation. By means of a logistic regression analy sis, a previous history of ulcer haemorrhage was identified as the onl y predictor associated with a significantly increased risk of recurren ce. The recurrence rate in 253 patients presenting with a first bleed at the index admission was 23%, compared with 73% in 27 patients with a history of bleeding before the index admission (p = 0.001). The rate of recurrence was not influenced by a history of previous uncomplicat ed ulcer disease or dyspeptic symptoms, the severity of the index blee d, the methods of management of the index bleed, age, use of non-stero idal anti-inflammatory drugs, or long-term treatment with cimetidine.