Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: A prospective database study in Italy

Background: Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. Objective: To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Design: Secondary analysis of prospectively collected data from 3 national databases. Settings: Community and teaching hospitals. Patients: Consecutive patients admitted for acute nonvariceal UGIB. Interventions: Early endoscopy, medical and endoscopic treatment as appropriate. Main Outcome Measurements: Thirty-day mortality, recurrent bleeding, and need for surgery. Results: A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P =.567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P