Peptic ulcer bleeding in intensive care unit (ICU): a prospective, controlled, randomized study

Background

In Slovenia the annual incidence of peptic ulcer hemorrhage is 118/100,000 inhabitants, with mortality up to 14%. Interventional endoscopy has largely reduced mortality in these patients.

Study aims

To compare the efficacy of argon plasma coagulation (APC) and injection sclerotherapy (IS) in endoscopic hemostasis and evaluate mortality in this potentially lethal medical emergency.

Study design

A prospective, controlled, randomized study.

Patients and methods

100 patients with bleeding peptic ulcer (m 63, f 37, av age 57.1 years, SD ± 16, span 26–80; gastric ulcer 50 pts, duodenal ulcer 50 pts;) were treated between 1.01.1999 and 15.05.2000 in ICU. Fifty patients were randomized to receive APC (ARCO 2000 ES unit, group A) and 50 patients IS (sclerosing with diluted adrenalin 1:10,000 plus polidocanol 1%; group B). The groups did not differ with respect to age, sex, site and severity of bleeding, additional diseases and NSAIDs intake. In ICU blood pressure and heart rate were continously monitored. Patients were receiving proton pump inhibitors, conventional supportive therapy, including i.v. fluids and transfusions as required.

Results

Clinically and endoscopically diagnosed rebleeding occured in 7/50 patients (14 %) in group A and in 9/50 patients (18%) in group B; OR 1.34, 95% CI 0.45–3.95. The majority of reebleding occured within 48 hours, group A 4/7 (57.1%), group B 7/9 (77.7%); P = 0.74. Repeated endoscopic hemostasis failed in 8 patients (8/100, 8%, group A 3, group B 5), OR 1.74, 95% CI 0.39–7.71. Seven patients were treated operatively. The total mortality rate was 9% (group A 4/50, 8%, group B 5/50, 10%), OR 1.27, 95% CI 0.32–5.06; only two patients died from gastrointestinal bleeding, other 7 patients died due to concomitant diseases.

Conclusions

APC seems to be an effective treatment modality in peptic ulcer bleeding. It is likely that improved endoscopic therapies, increased sophistication of ICU and better trained personnel are responsible for the decline in mortality from bleeding peptic ulcer in the last decade.