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Comparative Study
. 2013 Apr;48(4):439-47.
doi: 10.3109/00365521.2012.763174. Epub 2013 Jan 29.

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

Jóhann P Hreinsson  1 , Evangelos Kalaitzakis, Sveinn Gudmundsson, Einar S Björnsson
Affiliations
Free PMC article
Comparative Study

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

Jóhann P Hreinsson et al. Scand J Gastroenterol. 2013 Apr.
Free PMC article

Abstract

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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Figures

Figure 1.
Figure 1.
A flow chart showing patients who were included in the study and the patient groups that were excluded. UGE = upper gastrointestinal gastroscopy; AUGIB = acute upper gastrointestinal bleeding.
See this image and copyright information in PMC

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