BLEEDING PEPTIC-ULCER - RISK-FACTORS FOR REBLEEDING AND SEQUENTIAL-CHANGES IN ENDOSCOPIC FINDINGS

From September 1991 to December 1992, a prospective study was conducte d to determine the risk factors and residual risk of rebleeding, and t he evolutionary endoscopic changes in peptic ulcers that rebled. Emerg ency endoscopies were performed on 452 patients with haematemesis or a melaena, or both within 24 hours of admission. If the lesions were ac tively bleeding, then the patients were treated with injection sclerot herapy. A multivariate analysis of clinical, laboratory, and endoscopi c variables of 204 patients with ulcer bleeding showed that hypovolaem ic shock, a non-bleeding visible vessel, and an adherent clot on the u lcer base were independently significant in predicting rebleeding (p < 0.05). Considering these three factors according to the estimates of their regression coefficients showed that a non-bleeding visible vesse l was the strongest predictor of rebleeding. The study of the residual risk of rebleeding after admission showed that most rebleeding episod es (94.1%), including all associated with hypovolaemic shock, surgical treatment, and death, occurred within 96 hours of admission. After th is time, the residual risk of rebleeding was less than 1%. Study of th e changes in endoscopic findings before and after rebleeding illustrat ed that all ulcers with a visible vessel or adherent clot showed at fo llow up endoscopy were derived from ulcers with initial major stigmata . It is concluded that hypovolaemic shock, a non-bleeding visible vess el, and an adherent clot on an ulcer base are of independent significa nce in predicting rebleeding. Observation for 96 hours is sufficient t o detect most rebleeding episodes after an initial bleed from peptic u lcer.