title: The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): Endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting.
abstract: OBJECTIVE
  From the Canadian Registry of patients with Upper Gastrointestinal Bleeding and Endoscopy (RUGBE), we determined clinical outcomes and explored the roles of endoscopic and pharmacologic therapies in a contemporary real-life setting.
  
  
  METHODS
  Analysis of randomly selected patients endoscoped for nonvariceal upper gastrointestinal bleeding at 18 community and tertiary care institutions between 1999 and 2002. Covariates and outcomes were defined a priori and 30-day follow-up obtained. Logistic regression models identified predictors of outcomes.
  
  
  RESULTS
  One thousand eight-hundred and sixty-nine patients were included (66 +/- 17 yr, 38% female, 2.5 +/- 1.6 comorbid conditions, hemoglobin, 96 +/- 27 g/L, 54% received a mean of 2.9 +/- 1.7 units of blood). Endoscopy was performed within 24 h in 76%, with ulcers (55%) most commonly noted. High-risk endoscopic stigmata and endoscopic therapy were reported in 37%. Rebleeding, surgery, and mortality rates were 14.1%, 6.5%, and 5.4%, respectively. Decreased rebleeding was significantly and independently associated with PPI use (85% of patients, mean daily dose 56 +/- 53 mg) in all patients regardless of endoscopic stigmata, (odds ratio (OR):0.53, 95% confidence interval, 95% CI:0.37-0.77) and endoscopic hemostasis in patients with high-risk stigmata (OR:0.39, 95% CI:0.25-0.61). PPI use (OR:0.18, 95% CI:0.04-0.80) and endoscopic therapy (OR:0.31, 95% CI:0.11-0.91) were also each independently associated with decreased mortality in patients with high-risk stigmata.
  
  
  CONCLUSIONS
  These results appear to confirm the protective role of endoscopic therapy in patients with high-risk stigmata, and suggest that acute use of PPIs may be associated with a reduction of rebleeding in all patients, and lower mortality in patients with high-risk stigmata. Independent prospective validation of these observational findings is now required.
authors.affiliation: Department of Medicine, Division of Gastroenterology, McGill University, Montreal, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Barkun
authors.forename: Sandrine
authors.initials: S
authors.lastname: Sabbah
authors.forename: Robert
authors.initials: R
authors.lastname: Enns
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Jamie
authors.initials: J
authors.lastname: Gregor
authors.forename: Richard N N
authors.initials: RN
authors.lastname: Fedorak
authors.forename: Elham
authors.initials: E
authors.lastname: Rahme
authors.forename: Youssef
authors.initials: Y
authors.lastname: Toubouti
authors.forename: Myriam
authors.initials: M
authors.lastname: Martel
authors.forename: Naoki
authors.initials: N
authors.lastname: Chiba
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Fallone
mesh_terms: D000368:Aged; D002170:Canada; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016481:Helicobacter Infections / Q000188:drug therapy; D016480:Helicobacter pylori; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors; D012044:Regression Analysis; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors