Long-Term Outcomes in Patients with Post-Bulbar Ulcer Bleeding Compared to Bulbar Ulcer Bleeding in the Duodenum

• Published in: Digestion Vol. 103; no. 2; pp. 126 - 132
• Main Authors: Sekiguchi, Hiromi, Shinozaki, Satoshi, Takezawa, Takahito, Osawa, Hiroyuki, Miura, Yoshimasa, Lefor, Alan Kawarai, Yamamoto, Hironori
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 2022
• Subjects: Duodenal Ulcer - complications; Duodenal Ulcer - therapy; Duodenum; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - etiology; Peptic Ulcer Hemorrhage - therapy; Proportional Hazards Models; Research Article; Retrospective Studies; Ulcer - complications; Ulcer - therapy; Patient outcome assessment; Duodenal ulcer; Melena; Helicobacter pylori; Gastrointestinal hemorrhage
• ISSN: 0012-2823; 1421-9867
• DOI: 10.1159/000519293

Background: Duodenal ulcers are classified into bulbar and post-bulbar ulcers. The aim of this study is to compare the long-term outcomes of patients with post-bulbar ulcer bleeding and those with bulbar ulcer bleeding. Methods: A total of 272 patients with hemorrhagic duodenal ulcers requiring hospitalization were included. Their medical records were retrospectively reviewed. Results: All patients were categorized as bulbar or post-bulbar bleeding ulcer groups. The post-bulbar ulcer group had more patients of advanced age, concurrent malignancy, diabetes mellitus, hypertension, cirrhosis, and chronic kidney disease undergoing hemodialysis. We performed long-term follow-up for an average of 2.6 years. The mortality rate during the follow-up period in the post-bulbar ulcer group was significantly higher than that in the bulbar ulcer group (p < 0.001). The PNED score was a better predictor of 30-day mortality compared to the complete Rockall score and the Glasgow-Blatchford Score. Predictors of mortality were evaluated using a Cox proportional hazards regression model. In multivariate analysis, post-bulbar ulcer, concurrent malignancy, cirrhosis, antiplatelet/anticoagulant use, and transfusion were significant predictors of mortality. Conclusions: Patients with post-bulbar ulcers have a poorer prognosis than those with bulbar ulcers. After the diagnosis of hemorrhagic post-bulbar duodenal ulcer, close follow-up is necessary.