OUTCOME OF PEPTIC-ULCER HEMORRHAGE TREATED ACCORDING TO A DEFINED APPROACH

The short- and long-term bleeding recurrence and mortality of 157 cons ecutive patients admitted emergently over a period of 2 years with an actively bleeding peptic ulcer were analyzed. They were treated unifor mly according to a defined approach where suitable candidates for surg ery were operated on early. The data of the 5-year follow-up were anal yzed by constructing life tables. There were 94 men and 63 women with a median age of 72.3 years; 83 ulcers were gastric and 74 duodenal. Th irty-one patients underwent an operation. Eleven patients (7%) died wi thin the first month, one in the surgical group. During the follow-up 13 patients rebled and 54 died, two of the deaths related to peptic ul cer disease. The Life table for rebleeding and nicer-related deaths sh owed a cumulative risk of 11.8% at 5 years, and the cumulative risk wa s not statistically different between patients according to their age (60 years and older versus younger), sex, the site of their ulcer (gas tric versus duodenal), or the type of treatment (conservative versus s urgical). With a well defined approach and early selective surgery, th e short-term mortality compares favorably with the usual 10% or more r eported. The high mortality rate during the follow-up reflects the adv anced age of patients with coexisting disease. This long-term follow-u p study could be used as a comparison against future studies evaluatin g nea therapies.