{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T22:52:32Z","timestamp":1772751152053,"version":"3.50.1"},"reference-count":15,"publisher":"BMJ","issue":"6426","license":[{"start":{"date-parts":[[1984,4,28]],"date-time":"1984-04-28T00:00:00Z","timestamp":451958400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br Med J (Clin Res Ed)"],"published-print":{"date-parts":[[1984,4,28]]},"abstract":"<jats:p>From October 1980 to September 1983 all patients with upper gastrointestinal bleeding were admitted to a centralised unit and investigated by early endoscopy. A total of 142 patients with a proved duodenal or gastric ulcer were randomised after stratification for age and site of ulcer to early (aggressive) surgical management or a delayed (conservative) policy. Significantly more operations (n = 42; 60%) were performed in the early than in the delayed (n = 9; 20%) groups (p less than 0.01). There were no deaths among the 42 patients under 60. The overall mortality in the 100 patients aged over 60 was 10% and when analysed on an \"intention to treat\" basis there was no difference between early and delayed surgery. When, however, an unrelated death from a bleeding colonic polyp was excluded and the data analysed on \"treatment received\" the mortality was only 2% in the early group compared with 13% in the delayed group (p less than 0.05). When analysis was confined to gastric ulcer the difference between early (0%) and delayed (24%) treatment was even greater. The results of this trial indicate that for patients over 60 an aggressive surgical policy is associated with a significant reduction in mortality.<\/jats:p>","DOI":"10.1136\/bmj.288.6426.1277","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"1277-1280","source":"Crossref","is-referenced-by-count":96,"title":["Optimal timing of operation for bleeding peptic ulcer: prospective randomised trial."],"prefix":"10.1136","volume":"288","author":[{"given":"D L","family":"Morris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P C","family":"Hawker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Brearley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Simms","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P W","family":"Dykes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M R","family":"Keighley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1984,4,28]]},"reference":[{"issue":"79","key":"ref_1","first-page":"644","article-title":"Ueber die chirurgische behandlung des magengeschwurs","volume":"1906","author":"Kronlien, R.U.","unstructured":"Kronlien RU. Ueber die chirurgische behandlung des magengeschwurs. Arch P Klin Chir 1906;79:644-66.","journal-title":"Arch P Klin Chir"},{"issue":"69","key":"ref_2","first-page":"291","article-title":"Surgical treatment of acute profuse gastric hemorrhage","volume":"1939","author":"Finsterer, H.","unstructured":"Finsterer H. Surgical treatment of acute profuse gastric hemorrhage. Surg Gynecol Obstet 1939;69:291-8.","journal-title":"Surg Gynecol Obstet"},{"issue":"207","key":"ref_3","first-page":"1477","article-title":"The vigorous diagnostic approach to upper gastrointestinal tract hemorrhage-a 23 year prospective study of 1400 patients","volume":"1969","author":"Palmer, E.D.","unstructured":"Palmer ED. The vigorous diagnostic approach to upper gastrointestinal tract hemorrhage-a 23 year prospective study of 1400 patients. 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QJ7 Med 1976;180:533-50."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1016\/S0140-6736(79)91803-8","article-title":"Effect of different operative policies on mortality from bleeding peptic ulcer","volume":"i:","author":"Dronfield, M.W.; Atkinson, M.; Langman, M.J.S.","year":"1979","unstructured":"Dronfield MW, Atkinson M, Langman MJS. Effect of different operative policies on mortality from bleeding peptic ulcer. Lancet 1979;i:1126-8.","journal-title":"Lancet"},{"key":"ref_9","first-page":"999","article-title":"Haematemesis and melaena with special reference to peptic ulcer","volume":"i:","author":"Frankel, G.J.; Truelove, S.C.","year":"1955","unstructured":";284:548-50. '0 Frankel GJ, Truelove SC. Haematemesis and melaena with special reference to peptic ulcer. Br MedJ7 1955;i:999-1002."},{"key":"ref_10","first-page":"166","article-title":"Hematemesis with special reference to causation and the factors influencing the mortality from bleeding peptic ulcers","volume":"30","author":"Avery-Jones, F.","year":"1956","unstructured":"Avery-Jones F. Hematemesis with special reference to causation and the factors influencing the mortality from bleeding peptic ulcers. Gastroenterology 1956;30:166-90.","journal-title":"Gastroenterology"},{"key":"ref_11","first-page":"7","article-title":"Haematemesis and melaena with special reference to factors influencing the outcome","volume":"ii:","author":"Schiller, K.F.R.; Truelove, S.C.; Gwyn Williams, D.","year":"1970","unstructured":"Schiller KFR, Truelove SC, Gwyn Williams D. Haematemesis and melaena with special reference to factors influencing the outcome. Br MedJ3 1970;ii:7-14."},{"key":"ref_12","volume-title":"Accepted 8 Februiary","year":"1984","unstructured":"(Accepted 8 Februiary 1984)"},{"key":"ref_13","article-title":"Calcium metabolism and bone","volume-title":"nutritional disorders of the elderly","author":"lNordin BEC","year":"1980","unstructured":"lNordin BEC. Calcium metabolism and bone. In: Exton-Smith AN, Caird Fl, eds. Metabolic and nutritional disorders of the elderly. Bristol: Wright, 1980."},{"key":"ref_14","article-title":"Assessment of anabolic steroids and calcitonin in the treatment of osteoporosis","author":"Chestnut, C.H.; Ivey, J.L.; Nelp, W.B.; Baylink, D.J.","year":"1979","unstructured":"Chestnut CH, Ivey JL, Nelp WB, Baylink DJ. Assessment of anabolic steroids and calcitonin in the treatment of osteoporosis. In: Barzel US, ed. Osteoporosis II. New York: Grune and Stratton, 1979."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1056\/NEJM198202253060802","article-title":"Effects of the fluoride\/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis","volume":"306","author":"Riggs, B.L.; Seeman, E.; Hodgson, S.; Taves, D.R.; O'Fallon, W.M.","year":"1982","unstructured":"Riggs BL, Seeman E, Hodgson S, Taves DR, O'Fallon WM. Effects of the fluoride\/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. 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