The later clinical course of haematemesis

Summary A study was conducted on the natural history of haematemesis in patients with peptic ulcer and in those with negative radiological examination, the bleed having occurred at least 5 years previously; excluded were those who had undergone emergency or interim surgery. No significant difference was found in the average severity of the bleed between the ulcer and non-ulcer groups, which were comparable in age-distributions. Routine follow-up after the haemorrhage was discontinued following correction of the post-haemorrhagic anaemia; the present haematological status was found to be satisfactory in the very great majority and it appears that the acute bleed bears little if any relationship to the process of chronic blood loss. Physical examination and liver function tests revealed no evidence of delayed hepatic damage ensuing as a consequence of transfusion. Recurrent haemorrhages occurred in similar proportions in the ulcer and non-ulcer groups; they revealed no particular time interval or features of significant distinction from those of the initial bleed. Persistence of dyspepsia showed no correlation with a bleeding tendency. There is a preponderance of blood group O in the ulcer and non-ulcer bleeders. The radiological presence of a peptic ulcer does not necessarily indicate that this is the source of the bleeding and it is suggested that the comparable features of the select group of ulcer cases of our series and the non-ulcer cases offer support to the view that the origin of the bleed in a fair proportion of instances is common to the two groups; the possibility of a derangement of the microvasculature as the operating mechanism is mooted.