Hypotension develops one to two hours before other symptoms in peptic ulcer rebleeding; a matched cohort study.

BACKGROUND: Rebleeding is a frequent complication of peptic ulcer bleeding (PUB) and is associated with increased mortality. Blood pressure and heart rate are two easy non-invasive measurements to evaluate the hemodynamics and therefore a standard observation during hospitalization. OBJECTIVE: We aimed to investigate the dynamics of systolic blood pressure and heart rate up to time of peptic ulcer rebleeding. DESIGN: Retrospective matched cohort study. Hemodynamics in patients with peptic ulcer rebleeding was compared to hemodynamics in a matched control group consisting of patients with PUB without rebleeding. Blood pressure and heart rate in the six hours up to diagnosis of rebleeding was compared with baseline in the case cohort as well as with the matched control group. RESULTS: Thirty-eight patients with peptic ulcer rebleeding and 66 controls were included. Mean age was 75 years, 62% were males and 30-day mortality was 23%. Baseline systolic blood pressure in cases was 114 mmHg. Compared to baseline, we found significant decrease in systolic blood pressure two hours before rebleeding (4 mmHg; p = 0.041) and one hour before rebleeding (14 mmHg; p = 0.0002). Mean systolic blood pressure 30 min before rebleeding was 89 mmHg. No significant change was found in heart rate (p = 0.99). In the control group no change was found in systolic blood pressure or heart rate. CONCLUSION: In patients with peptic ulcer rebleeding, hypotension develops 1-2 h before other symptoms of rebleeding. Thus, close monitoring of blood pressure is needed in order to ensure early identification of rebleeding in high-risk patients.

[Risk scoring systems for assessment of patients with upper gastrointestinal bleeding].

Many scoring systems have been developed to predict various outcomes in patients with upper gastrointestinal bleeding (UGIB) including need-for-intervention, endoscopy, transfusion and/or death. This review summarises the present knowledge of the various scoring systems. It has been impossible to develop one score to predict all outcomes of interest. Glasgow-Blatchford Score (GBS) is shown to be superior to predict hospital-based intervention or death. For mortality, the newly developed ABC score seems promising. International guidelines recommend routine use of GBS to assess patients with UGIB, which is shown to reduce hospital admissions, length-of-stay and cost utilisation.