Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy

Background: Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. Objective: To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Design: Secondary analysis of prospectively collected data from 3 national databases. Settings: Community and teaching hospitals. Patients: Consecutive patients admitted for acute nonvariceal UGIB. Interventions: Early endoscopy, medical and endoscopic treatment as appropriate. Main Outcome Measurements: Thirty-day mortality, recurrent bleeding, and need for surgery. Results: A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P < .0001). Gastric or duodenal ulcer significantly increased the risk of death, but this was not related to the presence of high-risk stigmata (P = .368). The strongest predictor of mortality for all causes of nonvariceal UGIB was the overall physical status of the patient measured with the American Society of Anesthesiologists score (1-2 vs 3-4, P < .001). Limitations: No data on the American Society of Anesthesiologists class score in the Prometeo study. Conclusions: Nonulcer causes of nonvariceal UGIB have a risk of death, similar to bleeding peptic ulcers in the clinical context of a high-risk patient. (Gastrointest Endosc 2012;75:263-72.)