[Upper gastrointestinal bleeding from ulcer: reduction of mortality by early elective surgical therapy of patients at risk].

Amount, activity and localisation of bleeding, as well as patient-specific risk factors were used to define a group of patients at risk who were treated electively early by surgical intervention, within the first 24-36 hours after onset of the primary bleeding. 147 patients were included in the study between 1982 and 1988, a bleeding gastric ulcer being present in 67 (46%), a bleeding prepyloric ulcer in 14 (9%), and a bleeding duodenal ulcer in 66 (45%). 135 (92%) patients had a bleeding activity of I and II in Forrest's classification. 94 patients were in the at risk group and underwent early selective surgical treatment. During the period of study 13 patients (8.8%) died, with a drastic reduction in mortality rate during the 1982-1988 period from 20 to 0%. Stoppage of bleeding was the aim of operative intervention; treatment of the ulcerative condition was undertaken in only 43%. Reduction of the mortality rate to zero is ascribed to the early treatment concept.