Accuracy of Prediction of Final Diagnosis by Three Methods of Investigation in Peptic Ulcer

This reference to haematemesis appeared in a treatise, published in 1830, by Abercrombie, first Physician to the King in Scotland. Well over a century later, and despite advancing knowledge in the fields of diagnosis and pathology, there is still considerable difficulty experienced during the acute stages of haemorrhage in identifying the cause of bleeding. In the extensive writings on the causes and proper management of haematemesis the initial diagnostic problems only too often become submerged in comfortable tables of final diagnosis. Peptic ulcer is undoubtedly the most important cause of the admission of patients for haematemesis and melaena. In Avery Jones' series (1956) of 1,910 admissions for this emergency, 1,764 were due to proved or probable peptic ulcer. Fraenkel and Truelove (1956) reviewed 845 patients admitted to hospital with haematemesis. Seven out of every 10 showed convincing evidence of a chronic peptic ulcer; acute ulcers accounted for haematemesis in a further one in every six patients. The other single causes, in both series, which contributed appreciable numbers were oesophageal varices and carcinoma of the stomach. Though in most patients with chronic ulcers radiological or operative confirmation is obtained, this is rarely so in the case of bleeding acute ulcers. Thus Needham and McConachie (1950) could give only an approximate estimate of the proportion of their patients with haematemesis who had bled from acute peptic ulcer. Avery Jones (1956) and Tanner (1954) achieved greater diagnostic accuracy by early gastroscopy combined with