Presenting symptom does not predict mortality or morbidity in patients presenting with non-variceal upper gastrointestinal bleeding.

Introduction: Upper gastrointestinal bleeding (UGIB) is the most common gastrointestinal emergency and is associated with substantial morbidity and mortality. Studies have shown a prevalence of up to 150 patients per 100 000 population, with a mortality of 3-10% despite current standards of care. Presentation of UGIB varies from frank hematemesis to coffee ground vomitus (CGV), and melena. CGV, defined as the passage of black material which is assumed to be blood, has traditionally been considered to represent lower-risk bleeding when compared with frank hematemesis or melena. Aim(s): We aimed to compare outcomes and their severity for patients presenting with non-variceal UGIB based on their presenting symptoms (hematemesis, CGV, and/or melena) in an Australian patient cohort. Method(s): Patients presenting with UGIB to three Australian centers (two tertiary hospitals and one regional hospital) were prospectively included over a 22-month period from 2016 to 2017. Data were collected by specialist registrars using a purpose-built smartphone app. Background demographics and presenting symptom of UGIB were recorded. Patients with UGIB secondary to variceal bleeding were excluded. Primary outcome was in-hospital mortality. Secondary outcomes were: a composite end-point of inpatient mortality, rebleeding, and endoscopic, radiological, or surgical intervention; blood transfusion requirement; intensive care unit (ICU) admission; rebleeding; and hospital length of stay (LOS). Result(s): A total of 703 patients were included in the study. Median age was 67 years (IQR, 51-79) and 63% were male. Overall in-hospital mortality was 3.7%, and 60 patients (8.5%) experienced rebleeding. Median LOS was 4 days (IQR, 3-7 days), and 417 patients (59%) required blood transfusion, with a median transfusion requirement of 2 units (IQR, 2-4 units). Sixty-seven patients (10%) required repeat endoscopy, eight (1.1%) proceeded to surgery, and 23 (3.3%) required radiological embolization. The