Impact of ethnicity in upper gastrointestinal hemorrhage

Abstract

Goals: To examine ethnicity's role in the etiology and outcome of upper gastrointestinal hemorrhage (UGIH).

Background: UGIH is a serious condition with considerable associated morbidity and mortality.

Materials and methods: We analyzed 2196 patients admitted with acute UGIH between January 2006 and February 2012. Complete clinical data were gathered prospectively and entered into our GI Bleed Registry, which captures demographic and clinical variables. Results were analyzed using the χ² analyses and the analysis of variance techniques with Tukey multiple comparisons.

Results: Among 2196 patients, 620 (28%) were black, 625 (29%) white, 881 (40%) Hispanic, and 70 (3%) were members of other ethnicities. Gastroduodenal ulcers (25%), esophageal varices (25%), and esophagitis (12%) were the most frequently identified causes of UGIH. Blacks experienced a high rate of gastroduodenal ulcers (199/620), whereas Hispanics most commonly had esophageal varices. In all ethnicities, the most common cause of bleeding in patients younger than 35 or older than 65 years was gastroduodenal ulcer disease. However, among patients aged 35 to 64 years, there were differences in the etiology of UGIH. Blacks aged 50 to 64 years frequently experienced gastroduodenal ulcers, whereas Hispanics aged 35 to 49 years typically had esophageal varices. Rebleeding rates were significantly lower in whites (5.8%) than in Hispanics (9.9%) or blacks (8.7%) (P=0.02).

Conclusions: By examining a diverse population, we conclude that UGIH may follow trends. Hispanics were likely to have esophageal varices and higher rebleeding rates, whereas blacks were likely to have ulcers and the highest mortality. Whites were equally likely to have ulcers or varices, but a lower rate of rebleeding.

Figure 1. Distribution of diagnoses across ethnic groups and age

The absolute frequency of gastroduodenal ulcers, esophageal varices, and all diagnoses are shown for Blacks (A), Hispanics (B), Whites (C), and all patients (D). *Includes gastric and duodenal ulcers (^†p< 0.001; ‡p< 0.01 vs. other ethnic groups).

Figure 2. Distribution of varices or ulcers across age and ethnic groups

The absolute frequency of patients with gastroduodenal ulcers (A) and esophageal varices (B) within each ethnic group in different age groups is depicted (^† p <0.001 vs. other ethnic groups).

Figure 3. Frequency of hepatitis among ethnic groups

In (A) the overall hepatitis rate (for hepatitis B and hepatitis C), diagnosed by antibody, RNA or DNA testing, is shown. In (B), the number of patients with bleeding, overall, and in those with hepatitis, among the different ethnic groups is shown. Hepatitis status was collected from 1/2010 until the conclusion of the study, including 847 patients.

Figure 4. Frequency of complications among ethnic groups with ulcer and variceal bleeding

The rebleeding (A) and mortality (B) rate among the patients presenting with gastroduodenal ulcers and esophageal varices among the various ethnic groups is shown.