Upper gastrointestinal (UGI) hemorrhage in cancer patients: Etiology and prognosis

The risk of mortality associated with acute UGI bleeding is significantly increased in cancer patients. The aims of this study were to characterize the causes of bleeding in cancer patients with respect to matched controls and to clarify the independent prognostic factors. Methods : From a cohort of 860 consecutive patients with UGI bleeding studied prospectively, we have selected all the patients with a history of cancer. For each such patient, a control was matched by age (±10 years), sex, use of NSAIDs, liver disease, renal function and onset of bleeding (as inpatient or outpatient). Results: There were 114 patients with cancer: 30% GI tract; 24% genito-urinary; 14% pancreas; 10% hepatobiliary. The mean age was 67±1 (SE) and 60% were males. 36% had metastatic disease. There were no significant differences between the cancer patients and the controls in the concomitant diseases, clinical presentation, coagulation profile or the distribution of peptic ulcers (DU-25%; GU-19%). Twelve percent of the cancer patients bled from a tumor. The rate of rebleeding was significantly higher in cancer patients (27 vs 14%; p=0.013), as was the overall mortality (23% and 8% respectively; p=0.003). This increased mortality persisted in all types of malignancies. The independent predictors of mortality were cancer and hyperbilirubinemia (≥x2 the normal; adjusted odds ratios 3.0 and 9.5 respectively, p<0.02). Conclusions: In cancer patients with UGI bleeding: 1: the risk of rebleeding and mortality was increased, irrespective of the type of malignancy. 2: A tumor was the cause of bleeding in 12%. 3: The distribution of peptic ulcers was similar to that of matched controls.