Upper GI bleed: Patients with combination of haematemesis and melaena had 50 % chance of suffering from peptic ulcer.

Clinical bottom line (level 4)

  1. Half of patients admitted with haematemesis or melaena had a peptic ulcer, 10% have varices and 3% had a Mallory-Weiss tear.
  2. Patients with haematemesis and no melaena were slightly less likely to have a peptic ulcer. The combination made a peptic ulcer slightly more likely.
  3. Black haematemesis made varices slightly less likely.
  4. Black haematemesis made a Mallory-Weiss tear unlikely.
Wara and Stodkilde: Scandinavian Journal of Gastroenterology 1985; 20: 72-78
Expires November 2002

The study

Setting: university hospital, Denmark

539 patients (aged 1 day to 96 years; median 64, 64% male) admitted with haematemesis or melaena

Independent ?blinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Reference standard:
  • endoscopy
Diagnostic test: bleeding pattern before admission
  • black haematemesis: vomiting of altered blood appearing as coffee grounds
  • red haematemesis: vomiting of red blood or clots
  • melaena: passage of black shiny stool or noted on rectal palpation

The evidence

pre-test probability of peptic ulcer: 51.21%, (95% CI: 47% to 55.43%)
pre-test probability of varices: 10.95%, (95% CI: 8.3% to 13.58%)
pre-test probability of Mallory-Weiss tear: 3.3%, (95% CI: 1.82% to 4.86%)

diagnostic test peptic ulcer no peptic ulcer LR
(95% CI)		 post-test probability
black haematemesis 34 75 0.43
(0.30 to 0.62) 		31%
black haematemesis with melaena 50 20 2.4
(1.5 to 3.9) 		71%
melaena only 56 42 1.3
(0.88 to 1.8) 		57%
red haematemesis 49 71 0.66
(0.48 to 0.91) 		41%
red haematemesis with melaena 87 55 1.5
(1.1 to 2.0) 		61%
total 276 263


diagnostic test varices no varices LR
(95% CI)		 post-test probability
red haematemesis with or without melaena 45 217 1.7
(1.4 to 2.0) 		17%
black haematemesis or melaena 14 263 0.43
(0.27 to 0.69) 		5%
total 59 480


diagnostic test Mallory-Weiss tear no Mallory-Weiss tear LR
(95% CI)		 post-test probability
red haematemesis with or without melaena 18 244 2.1
(2.0 to 2.3) 		7%
black haematemesis or melaena 0 277 0.0
(0.0 to 0.29) 		0%
total 18 521

Comments

  1. Endoscopy failed to establish a cause in 13% of cases (95% CI: 10% to 16%).

Citation

  1. Wara P, and Stodkilde H: bleeding pattern before admission as guideline for emergency endoscopy. Scandinavian Journal of Gastroenterology 1985; 20: 72-78
Search Terms: ?
Contributor: Chris Ball and Musab Hayatli, November 1999
Reviewer:

Clinical Question.
Patient bloody vomit, black stool
Intervention or Exposure report of symptoms, colour
Outcome source of bleeding