Treatment of acute upper gastrointestinal bleeding: a retrospective study of the results in a surgical clinic.

OBJECTIVE

To review our results of the treatment of acute upper gastrointestinal bleeding since 1990.

DESIGN

Retrospective study.

SETTING

District hospital.

SUBJECTS

226 patients who presented with acute upper gastrointestinal bleeding between January 1990 and April 1992.

INTERVENTIONS

Upper gastrointestinal endoscopy and, in 15 cases, emergency laparotomy.

MAIN OUTCOME MEASURES

Morbidity and mortality, and the incidence of emergency operations.

RESULTS

There were 5 deaths (4%) and 11 emergency operations (10%) in 1990, compared with one death (1%) and 4 operations (4%) during the subsequent 16 months. Duration of hospital stay was reduced from a mean of 7 days to a mean of 6 days and the amount of blood transfused from a mean of 3.4 units to a mean of 2.4 (p < 0.02) over the same period. 149 patients (66%) were over the age of 65 years, 82 (36%) were taking potentially dangerous drugs, and 129 (57%) had serious coexistent diseases.

CONCLUSION

We conclude that the natural history of acute upper gastrointestinal bleeding may be changing, and that our "one team" approach comprising immediate resuscitation, urgent endoscopy, emergency operation when indicated, and intensive nursing, is responsible for the improvement in our results over the period of time studied.