Management strategies and outcomes in Peptic Ulcer Bleeding: Insights from a Retrospective Study at a Tertiary Care Hospital

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Aims Peptic ulcer bleeding (UGIB) may manifest with varying degrees of clinical severity, and its prognosis can be influenced by comorbidities. We aimed to evaluate clinical presentation and outcomes associated with the management of PUB. Methods Retrospective evaluation of 146 consecutive patients admitted to a tertiary hospital with UGIB betweenJan2018-Dec2019.Clinical parameters,use of anti-platelets, anticoagulants, pre-endoscopic Rockall score(RS) and Glasgow Blatchford score(GBS)were evaluated.Time to endoscopy,ulcer characteristics, hemostatic techniques, duration of hospitalization and in-hospital mortality were also analyzed. Qualitative variables were expressed as percentages and compared with Chi-square test.Quantitative variables with non-normal distribution were expressed as median(min-max)and compared with Mann-Whitney test. Results Median age was 71(18-97) years, with 107(73%) males. At least one comorbidity was documented in 101 (69%) patients: diabetes (n=43; 29%) and ischemic heart disease (n=39; 27%).Antiplatelet therapy was used in 47 cases(32%), and anticoagulant therapy was in 34 (23%) patients. At admission, 74 (51%) patients had hemodynamic compromise, and 35 (24%) required ICU admission. Pre-endoscopic median RS was 4(0-10), and GBS was 11(2-19). Early endoscopy (<24h) was perfomed in 106(73%) patients. The majority of PUB were in the bulbus (43;30%), gastric antrum (38; 26%) and gastric corpus (25;17%).Endoscopic findings of PUB were: ForrestIIa-42(28%),ForrestIII -34(23%), ForrestIIb-21(14%), Forrest Ia-11(8%), ForrestIb-17(12%).Endoscopic hemostasis was performed in 96(66%) patients.Thermal methods were used in 58 (60%), mechanical methods (TTSC/over-the-scope clip) in 26(27%) and a combination of both in 9(9%) patients.2 (2%) patients received adrenalin alone and 1 received hemospray (1%). There were no differences in the efficacy of the hemostatic methods. Second-look endoscopy was performed in 19(13%) patients, and only 2 required additional hemostasis.Chronic respiratory disease was significantly associated with rebleeding and need for surgical hemostasis(p=0.002).Surgery was performed in 9 patients (recurrent bleeding and failure of hemostasis with repeat endoscopy-5; transmural penetrating ulcer identified during index endoscopy-4).Gastric ulcer was associated with higher age(p=0.009), heart failure(p=0.03), chronic respiratory disease(p=0.02), anticoagulant use(p<0.006) and longer hospitalization (p=0.032). Median duration of hospitalization was 6(1-106) days and in-hospital mortality was 16 (11%). Cirrhosis (p=0.030), and oncological disease (p=0.003) were significantly associated with in-hospital mortality rates. Conclusions Patients presenting with PUB have advanced age with majority being men. Comorbidities are observed in more than 2/3 of patients. Gastric PUB was associated with higher age, chronic respiratory disease, anticoagulant use, and longer hospitalization. Cirrhosis and oncological disease increased the in-hospital mortality risk. Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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