The causes and consequences of gross hemorrhages from the upper gastrointestinal tract have been studied in 300 cases. Peptic ulceration of stomach, duodenum, or jejunum was responsible in 70% of the cases, and duodenal ulcer was the characteristic lesion in patients under 41 years of age. In the older patients, serious complicating disease occurred five times as often as in the younger. Melena was the universal symptom. Hematemesis occurred in approximately 60% of the patients. The crude mortality rate for the entire series was 14%. None of the deaths occurred among the 161 patients in whom duodenal ulcer was the primary problem. In cases of bleeding esophageal varices, however, the survival rate was less than 50%, all of the deaths being associated with advanced cirrhosis of the liver. Internist, surgeon, and radiologist should cooperate as a team in an effort to reach an accurate diagnosis within 12 to 24 hours after such a hemorrhage. Blood transfusions should be given as necessary to restore and maintain an effective circulation. A patient who gives evidence of renewed bleeding any time after six to eight hours in the hospital will almost certainly require surgery. The decision, once made, should be carried out promptly.
Weber JM, Nash EC, Gregg LA. HEMORRHAGE FROM THE UPPER GASTROINTESTINAL TRACTREPORT OF THREE HUNDRED CASES AND DISCUSSION OF TREATMENT. JAMA. 1957;165(15):1899–1905. doi:10.1001/jama.1957.02980330001001
Customize your JAMA Network experience by selecting one or more topics from the list below.