Prognosis

• inpatients ^a  
• patients with varices ^a  

The Rockall score can help rank your patient for risk of rebleeding and mortality

a	score 0	score 1	score 2	score 3
age	aged < 60	aged 60 to 79	aged > 80
shock	pulse < 100; systolic bp > 100 mmHg	pulse > 100; systolic bp > 100 mmHg	pulse >100; systolic bp < 100 mmHg
co-morbidity	no major co-morbidity		cardiac failure; ischaemic heart disease; any other co-morbidity	renal failure; liver failure; disseminated malignancy
endoscopic stigmata	none; dark spot seen		blood in upper GI tract; adherent clot; visible or spurting vessel
diagnosis	Mallory-Weiss tear; no lesion seen and no stigmata of recent haemorrhage	all other diagnoses	malignancy of upper GI tract

pre-endoscopy score a	death % (95% CI)
7	75%  (45% to 100%)
6	62%  (50% to 73%)
5	35%  (27% to 43%)
4	21%  (17% to 25%)
3	12%  (8.6% to 16%)
2	5.6%  (2.8% to 8.5%)
1	3.0%  (0.63% to 5.3%)
0	0.0%  (0.0% to 1.2%)

post-endoscopy score a	death % (95% CI)	rebleeding (95% CI)
8+	40%  (30% to 51%)	37%  (27% to 47%)
7	23%  (15% to 31%)	37%  (28% to 46%)
6	12%  (6.3% to 17%)	27%  (20% to 34%)
5	11%  (6.3% to 15%)	25%  (19% to 31%)
4	8.0%  (4.0% to 12%)	15%  (10% to 21%)
3	1.9%  (0.0% to 3.9%)	12%  (6.8% to 17%)
0 to 2	0.0%  (0.0% to 0.93%)	5.9%  (3.3% to 8.5%)

Ulcers

Peptic ulcers heal slowly and relapses are common ^c  

Ulcers are less likely to heal 

• with increasing age ^b
• with cigarette smoking ^b
• in men ^b
• with persisting ulcer symptoms ^b
• with a duodenal ulcer diameter larger than 20 mm ^b

• duodenal ulcer
• psychological stress
• endoscopic findings of scars at ulcer sites on healing
• no acute therapy

The risk of dying from varices is increased with ^a

• worsening Pugh score
• alcoholism
• increasing age
• hepatocellular carcinoma