Short summary

Peptic ulcer bleeding is common with 1,000-2,000 admissions a year in Denmark, with mortality rates at 8%-12%. Furthermore, rebleeding is a known complication, which can be seen for up to 10%-15% of the peptic ulcer bleeding patients (PUB), which is followed by a 3-5 fold increase in mortality.

To our knowledge, no studies have yet examined arterial lactate measured for 3 consecutive days as a predictor for rebleeding. If significant lactate concentrations between patients are observed, it might change how we observe admitted PUB patients.

Rationale

Studies have tried to predict which patients that rebleed, but these studies have included other causes of bleeding such as esophagitis, Mallory-Wiss lesions and neoplasia, which because of the lower risk of rebleeding might not be transferable to PUB.

Studies investigating predictors for rebleeding have found, that active bleeding, ulcus localized to the duodenum or lesser gastric curvature and hemodynamic instability have been associated with an increased risk for rebleeding.

Scoring systems such as Glasgow-Blatchford Score (GBS), Rockall Score (RS) and AIMS65 have been applied to try to predict the risk of rebleeding and mortality. The results have not been compelling, and some of the studies have tried a combination of scoring systems and arterial lactate taken in the acute phase, which have not been able to increase the discriminative ability even though lactate has predicted increased mortality in patients with severe sepsis or shock. Lack of correlation between lactate and complications such as rebleeding or mortality in these studies could be because of time blood sampling. The lactate was taken at admission, which might be too early for lactate to increase. A Danish study have shown that 79%-88% of the rebleedings occur in the first 72 hours.

To our knowledge, studies have not yet tried to examine the correlation between arterial lactate measured over the first 72 hours and the risk of rebleeding.

Purpose:
1) The main purpose for this research project is to investigate the application of arterial lactate as a predictor for rebleeding in patients with righ-risk peptic ulcer bleeding. To examine this, the pre-graduate student will tage an arterial blood sample 3 times a day (8 am, 2 pm and 8 pm) for 3 consecutive days, starting the day efter endoscopy. At presentation at the emergency room, an arterial blood sample will also be taken as part of the normal procedure. This blood sample will be included as well.

2) Furthermore, an examination of arterial lactate as an assessment tool for normalization of homeostasis after peptic ulcer bleeding will be performed.

Studydesign:
Patients with peptic ulcer bleeding who is endoscopically treated fir chronic ulcerations with active bleeding or non-bleeding visible blood vessel (Forrest classification I-IIA) in the department of Gastroenterology and Hepatology, dep. S, Odense University Hospital (OUH) is included in a prospective cohort design in a period between September 2020 and June 2021. Arterial lactate is measured at admissions and 3 times a day at 8 am, 2 pm and 8 pm in the 3 consecutive days efter endoscopic treatment or until rebleeding.

Description of the cohort

It is estimated that approximately 80 patients will participate in this study. Patients above 18 admitted with a peptic ulcer bleeding Forrest classification 1a, 1b or 2a. Exclusion criteria are patients without consent and where arterial puncture is not technically possible or safe.

Data and biological material

Arterial blood sample - lactate

Collaborating researchers and departments

Department of Medical Gastrointestinal Diseases, Odense University Hospital

• Post.doc., Stig Borbjerg Laursen, PhD
• Medical Student, Nikolaj Vestergaard Carlsen