Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting

Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastroint...

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Bibliographic Details
Published in:Scandinavian Journal of Gastroenterology
Main Authors: Hreinsson, Johann P., Kalaitzakis, Evangelos, Gudmundsson, Sveinn, Bjornsson, Einar S.
Format: Article in Journal/Newspaper
Language:English
Published: Taylor & Francis 2013
Subjects:
Gastroenterology and Hepatology
anti-inflammatory agents
gastrointestinal hemorrhage
hematemesis
low-dose aspirin
melena
non-steroidal
Iceland
Online Access:https://lup.lub.lu.se/record/3749092
https://doi.org/10.3109/00365521.2012.763174
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Summary:Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age-and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB. Results. A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004). Conclusions. LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.

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