Mortality in high-risk patients with bleeding Mallory–Weiss syndrome is similar to that of peptic ulcer bleeding. Results of a prospective database study

Abstract

Objective. The aim of this study was to identify the predictive factors influencing mortality in patients with bleeding Mallory–Weiss syndrome in comparison with peptic ulcer bleeding. Material and methods. Between January 2005 and December 2009, 281 patients with endoscopically confirmed Mallory–Weiss syndrome and 1530 patients with peptic ulcer bleeding were consecutively evaluated. The 30-day mortality and clinical outcome were related to the patients' demographic data, endoscopic, and clinical characteristics. Results. The one-year cumulative incidence for bleeding Mallory–Weiss syndrome was 7.3 cases/100,000 people and for peptic ulcer bleeding 40.4 cases/100,000 people. The age-standardized incidence for both bleeding Mallory–Weiss syndrome and peptic ulcer bleeding remained unchanged during the observational five-year period. The majority of patients with bleeding Mallory–Weiss syndrome were male patients with significant overall comorbidities (ASA class 3–4). Overall 30-day mortality rate was 5.3% for patients with bleeding Mallory–Weiss syndrome and 4.6% for patients with peptic ulcer bleeding (p = 0.578). In both patients with bleeding Mallory–Weiss syndrome and peptic ulcer bleeding, mortality was significantly higher in patients over 65 years of age and those with significant overall comorbidities (ASA class 3–4). Conclusion. The incidence of bleeding Mallory–Weiss syndrome and peptic ulcer bleeding has not changed over a five-year observational period. The overall 30-day mortality was almost equal for both bleeding Mallory–Weiss syndrome and peptic ulcer bleeding and was positively correlated to older age and underlying comorbid illnesses.

Key Words::

• bleeding
• clinical outcome
• Mallory–Weiss syndrome
• peptic ulcer

Acknowledgments

All authors have made substantial contributions to all of the following: the conception and design of the study, acquisition of data, analysis and interpretation of data. All authors have made substantial contributions to drafting the article and revising it critically for important intellectual content. The study was designed by NLJ. Data were acquired by NLJ, IB, TP, AB, ZP, AB, DZ, and BT. NLJ and IB analyzed the data and NLJ wrote the manuscript. All authors have made substantial contributions to the final approval of the version to be submitted. The manuscript, including related data, figures and tables has not been previously published and is not under consideration elsewhere.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.