Upper GI Bleeding–Associated Mortality: Challenges To Improving A Resistant Outcome

Although the incidence of peptic ulcer bleeding (PUB) has decreased, mortality has remained constant despite the advances in endoscopic and pharmacological therapies. Recent data indicate that most PUB-linked deaths are not direct sequelae of the bleeding ulcer itself. Instead, mortality derives from multi-organ failure, cardiopulmonary conditions, or terminal malignancy, suggesting that improving treatments for the bleeding ulcer may impact mortality by very little. Recognizing this possibility is paramount for the implementation of strategies that provide supportive care and prevent complications and key-organ failure, as well as treat the ulcer. Identifying non-gastrointestinal (GI) risk factors for poor outcomes and a multidisciplinary approach for high-risk patients should help to affect this hard outcome.