Endoscopy within 24 hours shows better outcomes in elderly with peptic ulcer bleeding

OAK BROOK, Ill. – August 17, 2009 – A new study shows that elderly patients who underwent endoscopy within one day of presentation for peptic ulcer bleeding had a two-day shorter hospital stay and were less likely to require upper gastrointestinal surgery than patients who did not receive endoscopy within the first day of presentation. Researchers from University Hospitals Case Medical Center in Cleveland, Ohio, note that unless specific contraindications exist, the data supports the routine use of early endoscopy for upper gastrointestinal bleeding. The study appears in the August issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

A peptic ulcer is a break in the lining of the stomach or duodenum, which is the beginning of the small intestine. The leading cause of peptic ulcers is an infection of the stomach by bacteria known as Helicobactor pylori. Other common causes are the chronic use of anti-inflammatory medicines and cigarette smoking. A peptic ulcer may bleed when either stomach acid or the ulcer penetrates and disrupts a blood vessel located just beneath it. Upper endoscopy, a procedure in which a thin, flexible tube with a light and a camera on the end is inserted through the mouth to help visualize the esophagus, stomach, and duodenum, is performed by a physician to diagnose and treat peptic ulcer bleeding. Upper endoscopy also helps physicians evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is the best method for detecting the cause of bleeding from the upper gastrointestinal tract and is more accurate than X-ray in detecting inflammation, ulcers, and tumors of the esophagus, stomach, and duodenum.

In 2006, there were an estimated 220,000 hospital discharges for upper gastrointestinal bleeding, with more than 118,000 of these attributed to peptic ulcer disease. Among patients with bleeding ulcers, the inpatient mortality (death) rate was 2.5 percent, the average length of hospital stay was 4.9 days, and the average hospital charges exceeded $28,000. Early upper endoscopy, defined as endoscopy performed within one day of the patient presenting with peptic ulcer bleeding, has been proposed as an intervention to improve efficiency and outcomes for these patients; however, the use and outcomes have not been studied in a national, U.S.-based sample.