Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesis

Loren Laine*, Stig B. Laursen, Liam Zakko, Harry R. Dalton, Jing H. Ngu, Michael Schultz, Adrian J. Stanley

*Kontaktforfatter for dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N =1209), coffee-grounds emesis without bloody emesis (N =701), or melena without hematemesis (N =1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody v. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Gastroenterology
Vol/bind113
Udgave nummer3
Sider (fra-til)358-366
ISSN0002-9270
DOI
StatusUdgivet - 1. mar. 2018

Fingeraftryk

Hematemesis
Coffee
Melena
Hemostatics

Citer dette

Laine, Loren ; Laursen, Stig B. ; Zakko, Liam ; Dalton, Harry R. ; Ngu, Jing H. ; Schultz, Michael ; Stanley, Adrian J. / Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesis. I: American Journal of Gastroenterology. 2018 ; Bind 113, Nr. 3. s. 358-366.
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title = "Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesis",
abstract = "OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N =1209), coffee-grounds emesis without bloody emesis (N =701), or melena without hematemesis (N =1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37{\%}), systolic blood pressure ≤100 mm Hg (12 vs. 12{\%}), and hemoglobin ≤100 g/l (25 vs. 27{\%}). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2{\%} for bloody v. coffee-grounds emesis; mortality was 6.6 vs. 9.3{\%}. Hemostatic intervention was more common (19.4 vs. 14.4{\%}) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5{\%}). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6{\%}; hemostatic intervention: 36.5 vs. 13.8{\%}) and coffee-grounds emesis (composite: 59.1 vs. 27.1{\%}; hemostatic intervention: 26.4 vs. 8.1{\%}). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.",
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author = "Loren Laine and Laursen, {Stig B.} and Liam Zakko and Dalton, {Harry R.} and Ngu, {Jing H.} and Michael Schultz and Stanley, {Adrian J.}",
year = "2018",
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Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesis. / Laine, Loren; Laursen, Stig B.; Zakko, Liam; Dalton, Harry R.; Ngu, Jing H.; Schultz, Michael; Stanley, Adrian J.

I: American Journal of Gastroenterology, Bind 113, Nr. 3, 01.03.2018, s. 358-366.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Severity and outcomes of upper gastrointestinal bleeding with bloody vs. coffee-grounds hematemesis

AU - Laine, Loren

AU - Laursen, Stig B.

AU - Zakko, Liam

AU - Dalton, Harry R.

AU - Ngu, Jing H.

AU - Schultz, Michael

AU - Stanley, Adrian J.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N =1209), coffee-grounds emesis without bloody emesis (N =701), or melena without hematemesis (N =1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody v. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.

AB - OBJECTIVES: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. METHODS: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N =1209), coffee-grounds emesis without bloody emesis (N =701), or melena without hematemesis (N =1069). We assessed bleeding severity (pulse, blood pressure) and predictors of outcome (hemoglobin, risk stratification scores) at presentation, and outcomes of bleeding episodes. The primary outcome was a composite of transfusion, intervention, or mortality. RESULTS: Bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min (35 vs. 37%), systolic blood pressure ≤100 mm Hg (12 vs. 12%), and hemoglobin ≤100 g/l (25 vs. 27%). Risk stratification scores were lower with bloody emesis. The composite end point was 34.7 vs. 38.2% for bloody v. coffee-grounds emesis; mortality was 6.6 vs. 9.3%. Hemostatic intervention was more common (19.4 vs. 14.4%) with bloody emesis (due to a higher frequency of varices necessitating endoscopic therapy), as was rebleeding (7.8 vs. 4.5%). Outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody (composite: 62.4 vs. 25.6%; hemostatic intervention: 36.5 vs. 13.8%) and coffee-grounds emesis (composite: 59.1 vs. 27.1%; hemostatic intervention: 26.4 vs. 8.1%). CONCLUSIONS: Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding. Outcomes with hematemesis are worsened with concurrent melena. The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy.

KW - Aged

KW - Blood Preservation

KW - Blood Transfusion/statistics & numerical data

KW - Esophageal and Gastric Varices/complications

KW - Female

KW - Gastrointestinal Hemorrhage/etiology

KW - Heart Rate

KW - Hematemesis/etiology

KW - Hemoglobins/metabolism

KW - Hemostasis, Endoscopic/statistics & numerical data

KW - Humans

KW - Male

KW - Melena/etiology

KW - Middle Aged

KW - Mortality

KW - Prospective Studies

KW - Recurrence

KW - Risk Assessment

KW - Severity of Illness Index

KW - Upper Gastrointestinal Tract

U2 - 10.1038/ajg.2018.5

DO - 10.1038/ajg.2018.5

M3 - Journal article

C2 - 29380820

AN - SCOPUS:85051269548

VL - 113

SP - 358

EP - 366

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 3

ER -