Value of a centralised approach in the management of haematemesis and melaena: experience in a district general hospital

All patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients adm...

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Bibliographic Details
Published in:Gut 1990-05, Vol.31 (5), p.504-508
Main Authors: Holman, R A, Davis, M, Gough, K R, Gartell, P, Britton, D C, Smith, R B
Format: Article
Language:English
Subjects:
Adult
Age Factors
Aged
Aged, 80 and over
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Aspirin - adverse effects
Biological and medical sciences
Female
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal Hemorrhage - mortality
Gastrointestinal Hemorrhage - surgery
Hematemesis - etiology
Hospital Units
Hospitals, District
Hospitals, General
Humans
Male
Medical sciences
Melena - etiology
Middle Aged
Other diseases. Semiology
Peptic Ulcer Hemorrhage - surgery
Recurrence
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
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Summary:All patients presenting with acute upper gastrointestinal bleeding between November 1986 and April 1988 were admitted to a centralised joint medical/surgical unit, with a policy of early clinical and endoscopic assessment and rapid surgical intervention in those at high risk. Of the 430 patients admitted 69.5% were over the age of 60 and 30% had significant additional medical conditions. 50.4% were bleeding from peptic ulcers and one third had been taking non-steroidal anti-inflammatory agents. Fifty five patients underwent surgery, which in two thirds was carried out within 24 hours of admission, usually for continued bleeding. In patients with peptic ulcer the operation rate was 21.6%. Overall mortality was 3.7%, and in those with bleeding gastric or duodenal ulcers 5.5%; surgical mortality in the later group was 15.2%. All patients who died had serious concomitant pathology and 87% were over 70 years of age. Adoption of a centralised approach to management of haematemasis and melaena is feasible in a District General Hospital and associated with an improved survival.
ISSN:0017-5749
1468-3288
1458-3288
DOI:10.1136/gut.31.5.504