Acute gastrointestinal bleeding: Experience of a specialized management team

Christopher J. Gostout, Kenneth K. Wang, David A. Ahlquist, Jonathan E. Clain, Rollin W. Hughes, M. V. Larson, Bret T. Petersen, Kenneth W. Schroeder, William J. Tremaine, Thomas R. Viggiano, Rita K. Balm

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84 Scopus citations

Abstract

The initial experience of a specialized management team organized to provide expedient care for all acute major gastrointestinal bleeding in protocolized fashion at a large referral center is presented. Of the 417 patients, 56% developed bleeding while hospitalized. Upper gastrointestinal bleeding accounted for 82%. The five most common etiologies included gastric ulcers (83 patients), duodenal ulcers (67 patients), erosions (41 patients), varices (35 patients), and diverticulosis (29 patients). Non-steroidal anti-inflammatory drugs were implicated in 53% of gastroduodenal ulcers. The incidence of nonbleeding visible vessels was 42% in gastric and 54% in duodenal ulcers. The rates of rebleeding were 24% (20 patients) in gastric ulcers and 28% (19 patients) in duodenal ulcers. Predictive factors for rebleeding included copious bright red blood, active arterial streaming, spurting, or a densely adherent clot. The rebleeding rate for esophagogastric varices was 57%. The mortality rate overall was 6% (27 patients), with rates varying from 3% (five patients) for gastroduodenal ulcers to 40% (14 patients) for esophagogastric varices. The morbidity rate for the entire patient population was 18% (77 patients), dominated by myocardial events (34 patients). The average length of hospitalization for gastroduodenal ulcers was 5 days, for diverticulosis 8 days, and for varices 10 days. The major efforts of a specialized Gastrointestinal Bleeding Team would be best directed at both reducing the morbidity associated with acute bleeding and reducing the overall cost of care.

Original languageEnglish (US)
Pages (from-to)260-267
Number of pages8
JournalJournal of clinical gastroenterology
Volume14
Issue number3
DOIs
StatePublished - Apr 1992

Keywords

  • Acute gastrointestinal bleeding
  • Diverticulosis
  • Peptic ulcers
  • Therapeutic endoscopy
  • Visible vessel

ASJC Scopus subject areas

  • Gastroenterology

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  • Cite this

    Gostout, C. J., Wang, K. K., Ahlquist, D. A., Clain, J. E., Hughes, R. W., Larson, M. V., Petersen, B. T., Schroeder, K. W., Tremaine, W. J., Viggiano, T. R., & Balm, R. K. (1992). Acute gastrointestinal bleeding: Experience of a specialized management team. Journal of clinical gastroenterology, 14(3), 260-267. https://doi.org/10.1097/00004836-199204000-00014