{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T18:03:40Z","timestamp":1765476220797,"version":"3.48.0"},"reference-count":13,"publisher":"BMJ","issue":"6490","license":[{"start":{"date-parts":[[1985,7,27]],"date-time":"1985-07-27T00:00:00Z","timestamp":491270400000},"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":[[1985,7,27]]},"abstract":"<jats:p>The incidence of rebleeding was studied prospectively in 177 patients with acute gastrointestinal haemorrhage from peptic ulceration with reference to the degree of haemodynamic insult on admission and the presence of endoscopic signs of recent haemorrhage on initial endoscopy. Rebleeding occurred in two (2%) of 114 patients without shock, in seven (18%) of 38 with tachycardia (pulse rate greater than 100 beats\/min, systolic blood pressure greater than 100 mm Hg), and in 12 (48%) of 25 with shock (systolic blood pressure less than 100 mm Hg). A similar gradient was noted with the presence of endoscopic signs alone. Rebleeding occurred in four (5%) of 79 patients with no endoscopic signs, in none of 40 with black spot only, in 11 (23%) of 48 with a clot, and in five (50%) of 10 with a visible vessel on endoscopy. When the incidence of rebleeding was assessed in shocked patients, however, it was significantly higher in those with important signs (clot or visible vessel), in 11 (79%) out of 14 patients, than in those with no signs, in one (9%) out of 11 (p less than 0.001). These data suggest that the association of shock with important endoscopic signs is a stronger predictor of rebleeding than either shock or important signs alone. More aggressive treatment may be warranted in this small group of patients.<\/jats:p>","DOI":"10.1136\/bmj.291.6490.245","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T11:00:59Z","timestamp":1238670059000},"page":"245-247","source":"Crossref","is-referenced-by-count":102,"title":["Importance of hypovolaemic shock and endoscopic signs in predicting recurrent haemorrhage from peptic ulceration: a prospective evaluation."],"prefix":"10.1136","volume":"291","author":[{"given":"P C","family":"Bornman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N A","family":"Theodorou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R D","family":"Shuttleworth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H P","family":"Essel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I N","family":"Marks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1985,7,27]]},"reference":[{"key":"ref_1","first-page":"237","article-title":"Clinical findings, early endoscopy, and multi variate analysis in patients bleeding from the upper gastrointestinal tract","volume":"ii:","author":"Morgan, A.G.; McAdam, W.A.F.; Walmsey, G.L.","year":"1977","unstructured":"Morgan AG, McAdam WAF, Walmsey GL, et al. Clinical findings, early endoscopy, and multi variate analysis in patients bleeding from the upper gastrointestinal tract. Br MedJ 1977;ii:237-40.","journal-title":"Br MedJ"},{"key":"ref_2","first-page":"245","article-title":"Bleeding peptic ulcer -with special reference to high-risk groups","volume-title":"of patients. Surgical Gastroenterology 1983; 2","author":"G, Van Stiegmann; PC, Bornman; J, Terbianche; IN, Marks","unstructured":"Van Stiegmann G, Bornman PC, Terbianche J, Marks IN. Bleeding peptic ulcer -with special reference to high-risk groups of patients. Surgical Gastroenterology 1983;2:245-51."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/0002-9610(77)90310-5","article-title":"Massive gastrointestinal hemorrhage in the elderly","volume":"134","author":"Chang, F.; Drake, J.E.; Farkes, G.J.","year":"1977","unstructured":"Chang F, Drake JE, Farkes GJ. Massive gastrointestinal hemorrhage in the elderly. AmJ Surg 1977;134:721-3.","journal-title":"AmJ Surg"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1136\/bmj.1.6173.1238","article-title":"Mortality in patients with haematemesis and melaena: a prospective study","volume":"i:","author":"Hunt, P.S.; Hansky, J.; Korman, M.G.","year":"1979","unstructured":"Hunt PS, Hansky J, Korman MG. Mortality in patients with haematemesis and melaena: a prospective study. Br Med J 1979;i:1238-40.","journal-title":"Br Med J"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1016\/S0140-6736(75)92085-1","article-title":"Impact of changes to early diagnosis and surgery in major upper gastrointestinal bleeding","volume":"ii:","author":"Hellers, G.; Ihre, T.","year":"1975","unstructured":"Hellers G, Ihre T. Impact of changes to early diagnosis and surgery in major upper gastrointestinal bleeding. Lancet 1975;ii:1250-1.","journal-title":"Lancet"},{"key":"ref_6","first-page":"1173","article-title":"Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding","volume":"i:","author":"Foster, D.N.; Miloszewski, K.G.A.; Losowsky, M.S.","year":"1978","unstructured":"Foster DN, Miloszewski KGA, Losowsky MS. Stigmata of recent haemorrhage in diagnosis and prognosis of upper gastrointestinal bleeding. Br Med J 1978; i:1173-7.","journal-title":"Br Med J"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1056\/NEJM198110153051603","article-title":"Endoscopic prediction of recurrent bleeding in peptic ulcers","volume":"305","author":"Storey, D.W.; Brown, S.G.; Swain, P.","year":"1981","unstructured":"Storey DW, Brown SG, Swain P, et al. Endoscopic prediction of recurrent bleeding in peptic ulcers. N Engl7 Med 1981;305:915-6.","journal-title":"N Engl7 Med"},{"key":"ref_8","first-page":"35","article-title":"Significance of signs of recent haemorrhage at endoscopy","volume":"ii:","author":"Harris, C.H.; Heap, T.R.","year":"1982","unstructured":"Harris CH, Heap TR. Significance of signs of recent haemorrhage at endoscopy. MedJ7 Aust 1982;ii:35-7."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1056\/NEJM197906213002503","article-title":"The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage","volume":"300","author":"Griffiths, W.J.; Neumann, D.A.; Welsh, J.D.","year":"1979","unstructured":"Griffiths WJ, Neumann DA, Welsh JD. The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage. N Engl J Med 1979; 300:1411.","journal-title":"N Engl J Med"},{"key":"ref_10","first-page":"1277","article-title":"Optimal timing of operation for bleeding peptic ulcer. Prospective randomised trial","volume":"7","author":"DL, C.Morris; PC, Hawker; S, Brearley","year":"1984","unstructured":"C Morris DL, Hawker PC, Brearley S, et al. Optimal timing of operation for bleeding peptic ulcer. Prospective randomised trial. Br Med 7 1984;288:1277-80.","journal-title":"Br Med"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1136\/bmj.284.6315.548","article-title":"Comparison of surgical and medical management of bleeding peptic ulcers","volume":"284","author":"Vellacott, K.D.; Dronfield, M.W.; Atkinson, M.; Langman, M.J.S.","year":"1982","unstructured":"Vellacott KD, Dronfield MW, Atkinson M, Langman MJS. Comparison of surgical and medical management of bleeding peptic ulcers. Br Med J 1982;284: 548-50.","journal-title":"Br Med J"},{"year":"1985","author":"Accepted","key":"ref_12","unstructured":"(Accepted 29 April 1985)"},{"key":"ref_13","unstructured":"Case 4-An 86 year old congenitally deaf and dumb woman was admitted with diarrhoea. Thyroid function tests disclosed slightly low serum thyroxine concentration but normal thyroid stimulating hormone. She had disproportionate pallor, periorbital oedema, myotonic jerks, thin skin, little pubic hair, and postural hypotension. She was found to have non-insulin dependent diabetes mellitus. Case 5-This patient first presented in 1976 with a history of blackouts for several years and longstanding pallor. Initial investigations showed low serum thyroxine and plasma sodium concentrations and low urinary sodium excretion. Skull x ray films were normal. Great improvement followed treatment with cortisone acetate and thyroxine. Eight years later he developed a rapidly growing carcinoma of bronchus, confirmed at necropsy.","article-title":"Case 4-An 86 year old congenitally deaf and dumb woman was admitted with diarrhoea. Thyroid function tests disclosed slightly low serum thyroxine concentration but normal thyroid stimulating hormone. She had disproportionate pallor, periorbital oedema, myotonic jerks, thin skin, little pubic hair, and postural hypotension. She was found to have non-insulin dependent diabetes mellitus. Case 5-This patient first presented in 1976 with a history of blackouts for several years and longstanding pallor. Initial investigations showed low serum thyroxine and plasma sodium concentrations and low urinary sodium excretion. Skull x ray films were normal. Great improvement followed treatment with cortisone acetate and thyroxine. Eight years later he developed a rapidly growing carcinoma of bronchus, confirmed at necropsy"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.291.6490.245","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.291.6490.245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T17:58:59Z","timestamp":1765475939000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.291.6490.245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1985,7,27]]},"references-count":13,"journal-issue":{"issue":"6490","published-online":{"date-parts":[[1985,7,27]]},"published-print":{"date-parts":[[1985,7,27]]}},"alternative-id":["10.1136\/bmj.291.6490.245"],"URL":"https:\/\/doi.org\/10.1136\/bmj.291.6490.245","relation":{},"ISSN":["0267-0623","1468-5833"],"issn-type":[{"type":"print","value":"0267-0623"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1985,7,27]]}}}