Reduction in mortality from upper gastrointestinal haemorrhage.

A study of 2377 cases of haemorrhage from the upper gastrointestinal tract shows a significant fall in mortality rate--from 15.5% in the period of retrospective study from 1961 to 1970 to 7% in the prospective study from 1972 to 1982. The fall in mortality rate from non-variceal bleeding was from 12.8% to 5%. In the second five years of the prospective study, the total mortality rate was 5.8%, with 4.5% for non-variceal haemorrhage. This improvement occurred despite a significant rise in the proportion of patients of 60 years of age and over, and was particularly evident in patients with bleeding chronic gastric ulcers. There was also a significant reduction in mortality in the 60 years and over age group in the latter five years of the prospective study. The data suggest that there were three aspects of management which were important in the reduction of mortality. These were early fibreoptic endoscopic diagnosis, improved resuscitation and postoperative care, and early control of bleeding from oesophageal varices by balloon tamponade and surgery in selected cases. These complicated procedural aspects of management are best applied in a special unit for the treatment of patients with haemorrhage from the upper gastrointestinal tract. It is concluded that there has been significant progress in the treatment of this problem during the last decade.