Incidence of haemorrhage from Dieulafoy's lesion in north-east Scotland

Dieulafoy's lesion is a rare but well-documented cause of severe gastrointestinal (GI) haemorrhage. However, there is little information available regarding the incidence of bleeding from this lesion. The GI Bleeding Unit (BU) at our institution is well placed to provide such data as over 95% of all acute GI bleeds in the north-east of Scotland are admitted directly to this unit, which serves a stable adult population of 468,000. Methods: Data on all admissions to the BU have been collected prospectively since its opening in October 1991. We reviewed the data on those patients with a diagnosis of Dieulafoy's lesion admitted between October 1991 and September 1994. Results: There were a total of 2567 patients admitted to the BU over the period of 3 years. Of the 1716 confirmed upper GI bleeds, 7 patients (0.4%) had a diagnosis of Dieulafoy's lesion. The mean age was 70 years (range 59-82) and 5 were males. Only one patient was a current smoker and only 2 had a regular alcohol intake. Five patients were taking non-steroidal anti-inflammatory drugs or aspirin, and one patient was on warfarin therapy. Six patients had significant co-morbid disease. Five of the patients presented with haemetemesis, of which 3 also had malaena; 2 patients presented with malaena only. Most of the patients had a significant GI haemorrhage as indicated by haemodynamic disturbance (4 patients), anaemia <10g/dl (4 patients) or a raised serum urea >7 mmol/1 (6 patients). Four patients had endoscopic therapy; one of these patients continued to bleed and proceeded to surgery. One additional patient had surgical treatment. The remaining 2 patients settled on conservative therapy. No deaths occurred and all of the seven patients were discharged home. Long term follow-up revealed that 2 patients had died, both from causes unrelated to GI haemorrhage. Four of the remaining 5 patients had further GI haemorrhage, 2 from Dieulafoy lesions. The incidence of haemorrhage from Dieulafoy's lesion was calculated to be 0.49 per 100 000 adult population in the north-east of Scotland. Conclusion: Dieulafoy's lesion is an uncommon cause of GI haemorrhage. Although the bleeding tends to be severe it can usually be managed with endoscopic therapy or surgery.