Prognostic factors in upper G.I. bleeding. 1986

F T de Dombal, and J R Clarke, and S E Clamp, and G Malizia, and M R Kotwal, and A G Morgan

This presentation draws upon the experience of the O.M.G.E. Multi-national Upper G.I. Bleeding Survey, using data collected during 1980-1982 by 185 clinicians from 44 centres in 21 countries to discuss two questions. First, can prognostic factors be identified in patients presenting to hospital with upper G.I. bleeding, and if so what are they? Second, is it possible - by combining the two technologies of endoscopy and computers - to provide an individual patient with a short-term prognostic prediction sufficiently accurate to affect patient management. Amongst 4,010 patients, a number of clinical factors were found to affect short-term prognosis. These included patient age, previous history of heart or liver disease, confusion and dehydration on admission, jaundice, and ascites. Identification of the bleeding source via endoscopy was shown to aid short-term prognosis - especially in the period of the 2nd to 10th days post-admission. Use of computer analysis enabled "high risk" patients to be defined (of whom 63.8% suffered further bleeding and 30.0% died), and also a comparable "low risk" group (of whom only 4% suffered further bleeding and none died). Finally, "time-dependence" studies have been used to identify a group of patients who (by the 2nd day post-admission) have a residual risk of further bleeding sufficiently low (well under 1%) to suggest that considerable resources can be saved by the judicious use of endoscopy and computer science.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010438 Peptic Ulcer Hemorrhage Bleeding from a PEPTIC ULCER that can be located in any segment of the GASTROINTESTINAL TRACT. Hemorrhage, Peptic Ulcer,Peptic Ulcer Hemorrhages,Ulcer Hemorrhage, Peptic
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D012008 Recurrence The return of a sign, symptom, or disease after a remission. Recrudescence,Relapse,Recrudescences,Recurrences,Relapses
D002986 Clinical Trials as Topic Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries. Clinical Trial as Topic
D003936 Diagnosis, Computer-Assisted Application of computer programs designed to assist the physician in solving a diagnostic problem. Computer-Assisted Diagnosis,Computer Assisted Diagnosis,Computer-Assisted Diagnoses,Diagnoses, Computer-Assisted,Diagnosis, Computer Assisted
D004724 Endoscopy Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body. Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D004932 Esophageal and Gastric Varices Dilated blood vessels in the ESOPHAGUS or GASTRIC FUNDUS that shunt blood from the portal circulation (PORTAL SYSTEM) to the systemic venous circulation. Often they are observed in individuals with portal hypertension (HYPERTENSION, PORTAL). Esophageal Varices,Gastric Varices,Esophageal Varix,Gastric Varix,Varices, Esophageal,Varices, Gastric,Varix, Esophageal,Varix, Gastric
D006471 Gastrointestinal Hemorrhage Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Hematochezia,Hemorrhage, Gastrointestinal,Gastrointestinal Hemorrhages,Hematochezias
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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