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KMID : 0882420080740050481
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Korean Journal of Medicine
2008 Volume.74 No. 5 p.481 ~ p.490
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Clinical characteristics and the risk factors for rebleeding in patients with bleeding peptic ulcer
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Choi Jin-Woo
Kim Na-Young
Song Ho-June
Lee Don-Hun
Yoo Ji-Youn
Kang Hyung-Min
Park Young-Soo
Hwang Jin-Hyeok
Kim Jin-Wook
Jeong Sook-Hyang
Lee Dong-Ho
Choi hang-Kyu
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Abstract
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Background/Aims : Bleeding is a serious complication of peptic ulcer. Although endoscopic therapy is effective for achieving hemostasis of active bleeding, rebleeding occurs in 10～30% of these patients. Recently, treatment with proton pump inhibitor (PPI) after hemostasis has decreased the rate of rebleeding. In this study, we analyzed risk factors of peptic ulcer rebleeding and we evaluated whether the rebleeding rate could be different depending on the PPI treatment method.
Methods : From March 2003 through February 2006, 639 patients visited the emergency room (ER) due to gastrointestinal hemorrhage. Among them, 191 patients were diagnosed to have peptic ulcer by endoscopy, and they were retrospectively analyzed for their clinical, laboratory and endoscopic findings. The PPI treatment method was categorized into the IV bolus group, the 8 mg/hr continuous infusion group and the others group.
Results : Emergency endoscopy was performed within 24 hours in 86.9% of the patients with bleeding peptic ulcer. Rebleeding occurred in 9 cases (4.7%) within 7 days after hemostasis. On the basis of univariate analysis, shock on ER arrival (p=0.013) and over 5 units of packed red cells (PRCs) transfusion (p=0.016) were significant risk factors for rebleeding, yet the PPI treatment method did not affect the rate of rebleeding.
Conclusions : The rebleeding rate of peptic ulcer in our study was 4.7%, and this was lower than the previous reports, and the rebleeding rate in our report may have been caused by the early hemostatic therapy together with intravenous infusion of PPI. These approaches are necessary as soon as the patients are stabilized, and especially for the group of patients who are at a high risk for rebleeding, such as those who experience shock at the ER and those who need over 5 units of PRC transfusion.
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KEYWORD
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Peptic ulcer, Rebleeding, Risk factor, Proton pump inhibitor
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