A study of the factors influencing mortality rates from gastrointestinal haemorrhage.

A prospective study is reported of 300 consecutive patients admitted to the General Hospital, Birmingham, because of acute gastrointestinal haemorrhage. The characteristics of the group have been outlined and the causes of death examined. It is shown that in patients diagnosed as having peptic ulcer or erosions, the major causes of death were thrombotic vascular disease and surgical complications. Current policies in the management of gastrointestinal bleeding are examined in this light, and it is concluded that gastric resection should be avoided wherever possible, and that procedures should be considered which might reduce intravascular clotting. The advisability of immediate surgery is also questioned and a case made for consideration of a policy of more prolonged resuscitation. A detailed analysis of mortality rates is included from reported European series, with particular reference to the increasing proportion of older patients. Taking this into consideration, it is argued that mortality rates are continuing to improve, and that early diagnosis must be an important contributory factor. It is also pointed out that not only are nearly half the patients in present studies over the age of sixty, but also the risk of developing such a haemorrhage is much greater in the older sections of the community. Gastrointestinal bleeding is more of a geriatric than an adolescent problem.