Loren Laine1,2, Stig B Laursen3, Liam Zakko1, Harry R Dalton4, Jing H Ngu5, Michael Schultz6, Adrian J Stanley7. 1. Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut, USA. 2. Section of Digestive Diseases, VA Connecticut Healthcare System, West Haven, Connecticut, USA. 3. Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark. 4. Gastrointestinal Unit, Royal Cornwall Hospital, Cornwall, UK. 5. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore. 6. Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. 7. Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
Abstract
OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody vs. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.
OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without bloody emesis (N=701), or melena without hematemesis (N=1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody vs. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS:Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.
Authors: Loren Laine; Brennan Spiegel; Alaa Rostom; Paul Moayyedi; Ernst J Kuipers; Marc Bardou; Joseph Sung; Alan N Barkun Journal: Am J Gastroenterol Date: 2009-12-22 Impact factor: 10.864
Authors: John R Saltzman; Ying P Tabak; Brian H Hyett; Xiaowu Sun; Anne C Travis; Richard S Johannes Journal: Gastrointest Endosc Date: 2011-09-10 Impact factor: 9.427
Authors: Loren Laine; Stig B Laursen; Harry R Dalton; Jing H Ngu; Michael Schultz; Adrian J Stanley Journal: Gastrointest Endosc Date: 2017-04-07 Impact factor: 9.427
Authors: Alan N Barkun; Marc Bardou; Ernst J Kuipers; Joseph Sung; Richard H Hunt; Myriam Martel; Paul Sinclair Journal: Ann Intern Med Date: 2010-01-19 Impact factor: 25.391
Authors: Adrian J Stanley; Loren Laine; Harry R Dalton; Jing H Ngu; Michael Schultz; Roseta Abazi; Liam Zakko; Susan Thornton; Kelly Wilkinson; Cristopher J L Khor; Iain A Murray; Stig B Laursen Journal: BMJ Date: 2017-01-04