Predictors for rebleeding of bleeding peptic ulcers characterized by flat spots in bases

From January 1993 to January 1995, we conducted a prospective study to investigate the natural history and predictors for rebleeding peptic ulcers which were characterized by flat pigmented spots. Emergency endoscopies were performed on 746 patients with hematemesis or melena, or both within 24 hours after admission. The patients with peptic ulcers marked by flat pigmented spots in ulcer bases were enrolled and 14 clinical parameters were recorded for analysis of predictors of rebleeding. Results: Among the 84 patients with flat pigmented spots in initial endoscopy, 3 (3.6%) rebled. All three rebleeding episodes were successfully treated by supportive care and/or therapeutic endoscopy. The overall mortality rate was 0%. The mean time lapse of rebleeding was 3.7 ± 0.6 days. Using Fisher exact test, hypovolemic shock emerged as a significant predictor for rebleeding (p < 0.05). The patients without hypovolemic shock had an extremely low residual risk of rebleeding (1.3%) even on admission; in contrast, subjects with hypovolemic shock faced a 50% rebleeding risk on admission, and it took 4 days to decrease the rebleeding risk to less than 3%. In summary, bleeding ulcers characterized by flat pigmented spots have a low risk of rebleeding and mortality. Hypovolemic shock is a significant predictor of rebleeding in the subpopulation. The patients with flat pigmented spots and stable hemodynamics are candidates for early discharge while patients with the same stigmata and hypovolemic shock should be observed in hospital for at least 4 days.