Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis.
Dr Loren Laine and colleagues assessed severity and outcomes related to bleeding symptoms in a prospective study.
Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis, coffee-grounds emesis without bloody emesis, or melena without hematemesis.
The researchers assessed bleeding severity, and predictors of outcome at presentation, and outcomes of bleeding episodes.
|The composite end point was 35 vs. 38% for bloody vs. coffee-grounds emesis|
|American Journal of Gastroenterology|
The team's primary outcome was a composite of transfusion, intervention, or mortality.
The team found that bloody and coffee-grounds emesis were similar in pulse ≥100 beats/min, systolic blood pressure ≤100 mm Hg, and hemoglobin ≤100 g/l.
Risk stratification scores were lower with bloody emesis.
The composite end point was 35 vs. 38% for bloody vs. coffee-grounds emesis.
The researchers observed that mortality was 7% vs. 9%.
Hemostatic intervention was more common with bloody emesis, as was rebleeding.
The team noted that outcomes were worse with hematemesis plus melena vs. isolated hematemesis for bloody and coffee-grounds emesis.
Dr Laine's team concludes, "Bloody emesis is not associated with more severe bleeding episodes at presentation or higher mortality than coffee-grounds emesis, but is associated with modestly higher rates of hemostatic intervention and rebleeding."
"Outcomes with hematemesis are worsened with concurrent melena."
"The presence of bloody emesis plus melena potentially could be considered in decisions regarding timing of endoscopy."