Upper gastrointestinal hemorrhage: aggressive management decreases mortality.

In a retrospective study of 630 patients with upper gastrointestinal hemorrhage admitted to the Royal Victoria Hospital between 1963 and 1971, the overall mortality was 12.54%. Mortality increased in patients receiving more than 10 units of blood and in patients over 60 years of age. Mortality decreased in patients in whom the site of hemorrhage was known prior to operation. Early surgery for gastric ulcers and conservative therapy for acute gastric erosions reduced mortality. Therefore in 334 patients admitted to the Royal Victoria Hospital between 1973 and 1976 with upper gastrointestinal hemorrhage, an aggressive approach to diagnosis and management was emphasized. There was a significant decrease in patients with duodenal ulcers, acute gastric erosions, and gastric ulcers who received more than 10 units of blood. There was a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant increase in the use of endoscopy to establish the source of hemorrhage and a significant decrease in the number of patients who did not have a diagnosis prior to operation. There was also a significant increase in early surgery for gastric ulcers. This regimen led to a significant decrease in mortality (6.69% vs. 12.54%). This report demonstrates that early diagnosis and management based on the lesion found reduces mortality from upper gastrointestinal hemorrhage.