From the Guidelines
The mortality rate of a duodenal ulcer hemorrhage is approximately 2-10% overall, as reported in the most recent study from 2024 1. This rate varies significantly based on several factors including patient age, comorbidities, severity of bleeding, and timing of medical intervention.
- Elderly patients (over 60 years) and those with significant comorbidities such as cardiovascular disease, liver disease, or malignancy face higher mortality rates, potentially reaching 15-20% 1.
- Rebleeding, which occurs in about 15-20% of cases, is associated with a two to three-fold increase in mortality risk.
- Prompt endoscopic intervention within 24 hours of presentation significantly improves outcomes, as recommended by the American College of Gastroenterology practice guidelines and an American Gastroenterological Association expert statement 1. Initial management typically includes:
- Intravenous proton pump inhibitors
- Fluid resuscitation
- Blood transfusion if hemoglobin falls below 7-8 g/dL. Endoscopic therapy with techniques like injection, thermal coagulation, or mechanical clips is the standard of care for actively bleeding ulcers. The mortality rate has decreased over recent decades due to advances in endoscopic techniques, improved critical care, and better pharmacological management of peptic ulcer disease, as noted in the 2024 update of the acr appropriateness criteria® nonvariceal upper gastrointestinal bleeding 1.
From the Research
Mortality Rate of Duodenal Ulcer Hemorrhage
- The mortality rate for patients with bleeding duodenal ulcers has been reported to be around 2.8% in one study 2.
- Another study found that the in-hospital mortality rate for patients with duodenal ulcers was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis 3.
- A retrospective cohort study found that the mortality rate for patients with chronic duodenal ulcers was 1.9% for non-elderly men and 2% for non-elderly women, while it was 4.5% for elderly men and 5.3% for elderly women 4.
- A study comparing surgery and transcatheter arterial embolization for bleeding duodenal ulcer refractory to endoscopic treatment found that mortality was similar between the two groups, at 14.2% and 15.3% respectively 5.
Risk Factors for Mortality
- Age, delayed operation, frailty, and presence of perforation were identified as risk factors for mortality in patients with duodenal ulcers 4.
- Ulcer size was also found to be a risk factor, with larger ulcers (>1 cm) having a higher risk of rebleeding and mortality 2.
- The presence of endoscopic stigmata of recent hemorrhage was also associated with an increased risk of rebleeding and mortality 2.
Treatment Outcomes
- Endoscopic hemostasis was found to have a success rate of 95.1% in one study, but rescue therapy was associated with lower hemostasis success and a more than ten-fold increase in mortality rate 3.
- Duodenal ulcers were associated with worse treatment outcomes and higher resource utilization compared to gastric ulcers 3.
- Transcatheter arterial embolization and surgery were found to have similar overall success rates and mortality rates in the treatment of bleeding duodenal ulcer refractory to endoscopic treatment 5.