A prospective study was undertaken to establish the etiology and prevalence of episodes of upper gastrointestinal bleeding which are severe and persistent. During a 12-mo study period, 175 patients had one or more episodes of upper gastrointestinal bleeding. Thirty-six (20.6%) of the 175 patients had bleeding that was classified as severe and persistent. Upper gastrointestinal bleeding that occurred more than 24 h after admission was more apt to persist than bleeding that was a presenting complaint (32.4% vs. 12.8%, p < 0.001). Bleeding due to esophageal varices was the single most common cause. Although the majority of upper gastrointestinal bleeding episodes are self-limited, about one-fifth are not. Studies to evaluate the many new therapeutic modalities for upper gastrointestinal bleeding should attempt to exclude patients whose bleeding will abate spontaneously.
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