Incidence, diagnosis, and natural course of upper gastrointestinal hemorrhage. Prognostic value of clinical factors and endoscopy.

Upper gastrointestinal bleeding is a common emergency, with a constant annual incidence of 90 patients per 100,000 population. Peptic ulcer marked by stigmata of hemorrhage is the commonest source of bleeding (51%), followed by varices (11%), esophagitis (10%), and erosions (5%). Most hemorrhages stop bleeding spontaneously (82%), whereas 18% present with major bleeding, mostly due to erosion of an artery in the ulcer base, requiring hemostatic intervention. Thirty per cent of the peptic ulcers bleed massively, constituting 89% of all major bleeds. Non-ulcer lesions rarely bleed massively (4%). Clinical factors including bleeding pattern before admission and endoscopically observed stigmata of hemorrhage including the visible vessel have been shown to be poor predictors of major hemorrhage. Hemodynamic monitoring remains the most reliable method for distinguishing between patients with major bleeding and need for emergency surgery and patients who will stop bleeding spontaneously.