Prognosis
For most patients, bleeding is self-limited, and will have stopped by the time of endoscopy. Prognosis is excellent in patients without associated disease or complications. A routine second endoscopic evaluation is not recommended unless the patient remains symptomatic after initial treatment.
The Rockall post-endoscopy score
Includes clinical criteria (increasing age, presence of comorbidities, shock) as well as endoscopic findings (such as source of bleeding and/or stigmata of recent bleeding) to identify patients at risk of adverse outcome after acute upper gastrointestinal bleeding.[37][100] The total score is calculated by simple addition. A score of <3 carries a good prognosis, but a total score of 8 or higher carries a high risk of mortality. Rockall score has been shown to be more accurate in predicting mortality (with an optimal cutoff of ≥4 for pre-endoscopy score and ≥5 for post-endoscopy Rockall) than the risk of rebleeding, but while the pre-endoscopic Rockall scale has good sensitivity, it may misclassify 4% to 7% of high-risk patients.[1][40] In the experience of the author, this score is not widely used outside of clinical research. [ Rockall Score for Upper Gastrointestinal Bleeding Opens in new window ]
Risk of rebleeding
Rebleeding occurs in about 8% to 15% of patients. It usually occurs within the first 24 hours and most often in patients with high-risk factors for rebleeding, including:[99]
old age (>65 years of age)
hematemesis and/or hematochezia at presentation
hemodynamic instability/shock
alcoholism
aspirin or nonsteroidal anti-inflammatory drug use
multiple blood transfusions
comorbidities (anemia, chronic liver disease, coronary artery disease, COPD, renal failure)
actively bleeding lesions.
Patients with high risk factors require more-intense monitoring and should be admitted to the hospital for evaluation for at least 48 hours.
Patients with no risk factors for rebleeding should be observed at the ER and discharged home.
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