Gastrointestinal Bleeding: Incidence, Etiology, Role of Drugs and Outcome.

• Main Author: Jóhann Páll Hreinsson 1987-
• Other Authors: Háskóli Íslands
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: 2014
• Subjects: Læknisfræði; Iceland
• Online Access: http://hdl.handle.net/1946/19900

Gastrointestinal bleeding (GIB) is a common reason for hospitalization and referral to endoscopy. Certain drugs seem to be associated with GIB, although their role in specific types of GIB and etiology is unclear. The outcome of patients with GIB seems to be favourable although long-term follow-up data is lacking. The aim of this thesis was to evaluate the incidence of gastrointestinal bleeding as well as to describe its etiology. Furthermore, to study the association of GIB and various drugs potentially associated with GIB and to determine the short- and long-term outcome in GIB patients. Lastly, to examine what proportion of patients with colorectal cancer have bleeding-related symptoms and what characterizes those patients. The total cohort of the thesis included all patients that underwent endoscopy at the National University Hospital of Iceland in 2010 and all of those who underwent colonoscopy in 2013 at the National University Hospital of Iceland. The indications and results of endoscopies were prospectively noted. Endoscopic nurses interviewed patients on drug history prior to endoscopy. Furthermore, drug history was obtained by reviewing medical records and by access to a nationwide pharmaceutical database. Patients were further divided to 4 main cohorts: patients with acute upper gastrointestinal bleeding (AUGIB) in 2010, patients with acute lower gastrointestinal bleeding (ALGIB) in 2010, patients with ALGIB in both 2010 and 2013 and lastly, patients with unexplained GIB in 2010. Patients with unexplained bleeding were further categorized to patients with: unexplained overt GIB, unexplained occult GIB, obscure GIB and clinical suspicion of bleeding. Unexplained bleeders were retrospectively followed-up for at least three years. Controls were selected from patients undergoing endoscopy in the same period and matched for gender and age (±5 years). In addition, all patients diagnosed with colorectal cancer in Iceland from 2008-2011 were identified via the Icelandic Cancer Registry and their medical ...