What is the prognosis for upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Answer

Recurrence of upper gastrointestinal (GI) bleeding (UGIB) is common. In a study to evaluate national 30-day readmissions after upper and lower gastrointestinal (GI) bleeding in US patients, of 82,290 patients admitted for UGIB, the all-cause 30-day readmission rate was 14.6% (vs 14.4% for LGIB). [31] The most common causes of UGIB were GI (33.9%), cardiac (13.3%), infectious (10.4%), and respiratory (7.8%). Significant predictors of 30-day readmission were metastatic disease, discharge against medical advice, and hospital stay for longer than 3 days. [31]

As previously mentioned, age older than 60 years is an independent marker for a poor outcome in UGIB, [32] with the mortality rate ranging from 12% to 25% in this group of patients.

The American Society for Gastrointestinal Endoscopy (ASGE) grouped patients with UGIB according to age and correlated age category to the risk of mortality. The ASGE found a mortality of 3.3% for patients aged 21-31 years, 10.1% for those aged 41-50 years, and 14.4% for those aged 71-80 years. [32]

The following risk factors are associated with an increased mortality, recurrent bleeding, the need for endoscopic hemostasis, or surgery [14, 33] :

  • Age older than 60 years

  • Severe comorbidity

  • Active bleeding (eg, witnessed hematemesis, red blood per nasogastric tube, fresh blood per rectum)

  • Hypotension

  • Red blood cell transfusion greater than or equal to 6 units

  • Inpatient at time of bleed

  • Severe coagulopathy

Patients who present in hemorrhagic shock have a mortality rate of up to 30%.


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