Primary and secondary nonvariceal upper gastrointestinal bleeding

BACKGROUND: Upper gastrointestinal (UGI) bleeding is associated with a mortality rate of up to 14% in emergency hospital admissions (primary bleeding), and up to 28% in hospitalized patients (secondary bleeding). AIM: To characterize and compare the clinical pictures and outcome of primary and secondary nonvariceal UGI bleeding. STUDY: A retrospective, case-control design was used. The files of all consecutive patients admitted to our tertiary academic center between January 1, 2001 and December 31, 2002 for UGI bleeding were reviewed for demographic and clinical data, treatment details, number of blood transfusions, endoscopic procedures, surgical procedures, and mortality. RESULTS: Compared to primary UGI bleeding, secondary bleeding was associated with female sex, older age, more chronic diseases, intake of more drugs, hospitalization in internal medicine departments, longer hospital stay, fewer endoscopic procedures, and less Helicobacter pylori-related peptic ulcer disease. Total mortality rate in the secondary bleeders was 30.3% versus 4.6% in the primary bleeders (P<0.0001). There was no significant difference between primary and secondary bleeders in treatment with nonsteroidal anti-inflammatory agents or aspirin, severity of bleeding, or death related to gastrointestinal bleeding. CONCLUSIONS: Despite the significant differences in the clinical picture of primary and secondary bleeders, the severity of bleeding appear to be similar in both groups. Although there was a trend towards a higher gastrointestinal-related mortality in secondary bleeders, it was not statistically significant.