RESUMO
OBJECTIVE: Blood transfusion remains an integral step in the management of acute non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being increasingly questioned in less severe cases. The authors aimed to measure 30-day and 2-year mortalities after blood transfusion for NV-UGIB. METHODS: Cox proportional hazards models were used to estimate the association of blood transfusion with mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute UGIB, admission status and medication intake prior to bleeding. MAIN OUTCOME MEASURES: Death from any cause at 30 days and 2 years after NV-UGIB. RESULTS: 1340 patients presented with NV-UGIB< (808 men (60.3%), median age 67 years) of whom 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 26.0% at 2 years in all patients. Comparing subjects with a haemoglobin concentration greater than 10.0 g/dl who were transfused with those who were not, 30-day mortalities (95% CIs) were 11.5% (6.7 to 18.0) versus 3.6% (2.3 to 5.3), respectively, p<0.001, and 2-year mortalities (95% CIs) were 40% (32 to 49) versus 20% (17 to 23), p<0.001. After adjusting for age, Charlson score, Rockall score and haemoglobin, the HRs (95% CIs) for death after transfusion were 1.88 (1.00 to 3.55) (p=0.051) at 30 days and 1.71 (1.28 to 2.28), (p<0.001) at 2 years. CONCLUSION: In patients with moderately severe NV-UGIB, mortality is higher following blood transfusion. Whether this reflects selection bias, an effect of comorbidity or an effect of transfusion requires urgent prospective study.
RESUMO
OBJECTIVE: Previous erosive oesophagitis studies have excluded patients with peptic ulcers or taking aspirin, and conflicting results have been reported concerning the influence of. We aimed to study the possible correlation between erosive oesophageal and gastro-duodenal diseases in patients with or without erosive oesophagitis who are taking low-dose aspirin, or simple analgesics, or those infected with. METHODS: Endoscopic oesophageal and gastro-duodenal lesions were graded in 287 patients with reflux oesophagitis, median age 57 years, including 168 with oesophageal erosions, 131 infected with, 45 patients taking aspirin 75 mg daily, and 65 patients taking simple analgesics containing paracetamol/codeine. RESULTS: The grades of oesophageal erosions correlated positively with the duodenal scores (r = 0.15; P = 0.01) in the study group as a whole (n = 287), and in patients (n = 131) with (r = 0.169; P = 0.05). Eighty of 168 patients with erosive oesophagitis had (48%), compared with 51 of 119 patients (43%) with non-erosive oesophageal disease (P = 0.47). Oesophageal scores were highest in the aspirin group (P = 0.04; Kruskal-Wallis test), with grades > or =3 being found in 36% of patients on aspirin, 22% on simple analgesics, and in 18% of other patients. CONCLUSIONS: The degree of oesophageal damage correlates positively with that in the duodenal mucosa, although the overall prevalence of erosive oesophagitis is not influenced by. Also, patients taking aspirin have a greater degree of oesophageal damage. These indicate the presence of a common process mediating both oesophageal and duodenal diseases in at least some patients with these disorders.
