Treatment and outcome of gastrointestinal bleeding due to peptic ulcers and erosions – (BLUE study)

Abstract

Objectives

Peptic ulcers and erosions are the most common causes of upper gastrointestinal bleeding. The aim of this study was to investigate the management and outcomes of these patients.

Materials and methods

A total of 543 patients with endoscopically confirmed bleeding from peptic ulcers and erosions were included from March 2015 to December 2017. The patient characteristics, endoscopic findings, Forrest classification and endoscopic treatment were recorded. Moreover, the rebleeding rates, repeated endoscopies and transcatheter angiographic embolization and surgery incidences were registered. A follow-up endoscopy after discharge from the hospital was scheduled.

Results

Among the patients, high-risk stigmata ulcers were present in 36% (198/543) and low-risk stigmata ulcers and erosions in 60% (327/543) at first endoscopy. Endoscopic therapy was performed in 30% (165/543) of the patients, and hemostasis was achieved in 94% (155/165). The incidence of rebleeding was 9% (49/543) for the whole cohort and 14.8% (23/155) for those patients who had received successful endoscopic treatment. Moreover, rebleeding was significantly more frequent in duodenal ulcers than in gastric ulcers (11.9% vs 4.0%, p = .004). In a multivariable analysis, rebleeding was significantly related to comorbidity and Forrest classification. Transcatheter angiographic embolization and surgery were required in 6% (34/543) and 0.07% (4/543) of patients, respectively. Complete peptic ulcer healing was found at follow-up in 73.3% (270/368) of patients.

Conclusions

Endoscopic hemostasis was achieved in the majority of patients with high-risk ulceration, although the occurrence of rebleeding is a significant challenge, especially in patients with duodenal ulcers. Clinical trial registration: Bleeding Ulcer and Erosions Study (BLUE Study), ClinicalTrials.gov identifier: NCT03367897.

Keywords:

• Peptic ulcer
• endoscopic therapy
• rebleeding
• upper gastrointestinal bleeding
• Forrest classification

Acknowledgments

Thanks to all participants in the BLUE study group who assisted with the data collection and to Professor Truls Micheal Leegaard M.D., Astri Lervik Larsen M.D. and Heidi Johanne Espvik M.D. at the Department of Microbiology, Akershus University Hospital for analyzing the H. pylori tests.

Disclosure statement

The authors report no conflict of interest. The funders had no role in the study design, data collection and analysis, or interpretation of data.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.

Additional information

Funding

Katrine Kauczynska Romstad was supported by a research grant from Østfold Hospital Trust. Marthe Eide Jahnsen was funded by Pharmacosmos.