Changes in aetiology and clinical outcome of acute upper gastrointestinal bleeding during the last 15 years.
OBJECTIVE
The diagnostic and therapeutic approaches to patients with acute upper gastrointestinal bleeding have been improved during the last decades. The aim of this study was to compare the aetiology and clinical outcome of acute upper gastrointestinal bleeding (AUGIB) between two distinct periods during the last 15 years.


METHODS
The causes of AUGIB and clinical outcome of 668 patients hospitalised with the problem in 1986-1987 were compared to 636 patients with AUGIB in 2000-2001. Patients were admitted to our hospital or they bled while they were inpatients for other reasons. No patient was excluded because of age or concurrent diseases. Endoscopic haemostasis with adrenaline injection for bleeding peptic ulcers was performed in the second period while no endoscopic method of haemostasis was performed in the first period.


RESULTS
We observed an increase in the age of patients (56.5 +/- 16.9 vs 62.9 +/- 17.5 years, P < 0.0001) and the percentage of patients who received non-steroidal anti-inflammatory drugs (NSAIDs) before bleeding (from 44% to 63.5%, P < 0.0001). An increase in the diagnosis rate of gastric ulcer (12% vs 19.2%, P = 0.005) and varices (13.2% vs 3.3%, P < 0.001) with a simultaneous decrease in that of erosive gastroduodenitis (18.4% vs 7.2%, P < 0.0001) and duodenal ulcer (48.7% vs 33.3%, P < 0.0001) as a cause of bleeding was also observed. In peptic ulcer bleeding, emergency surgical haemostasis was reduced from 14% to 5.3%, P < 0.001. Overall mortality was also reduced from 5.2% to 3.1% and in peptic ulcer bleeding patients from 3.3% to 2.4%, respectively, but the differences are not statistically significant.


CONCLUSIONS
The aetiology of AUGIB has changed during the last 15 years probably due to the better therapeutic approach to chronic duodenal ulcers and increasing use of NSAIDs in the elderly. Emergency surgical haemostasis has been reduced but the reduction of mortality was not significant.
Thomopoulos
Konstantinos C
KC
Department of Internal Medicine, Division of Gastroenterology, University Hospital, Patras, Greece.
Vagenas
Konstantinos A
KA
Vagianos
Constantine E
CE
Margaritis
Vassilios G
VG
Blikas
Alexandros P
AP
Katsakoulis
Evangelos C
EC
Nikolopoulou
Vassiliki N
VN
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000150:complications; D004382:Duodenitis / Q000150:complications; D004630:Emergencies; D004932:Esophageal and Gastric Varices / Q000150:complications; D005260:Female; D005756:Gastritis / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000150:complications; D011379:Prognosis; D013276:Stomach Ulcer / Q000150:complications
D000894:Anti-Inflammatory Agents, Non-Steroidal