title: Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a multicentre French study.
abstract: OBJECTIVE
  To evaluate the main changes in characteristics, practices and outcome between 1996 and 2000 in patients admitted for an acute upper gastrointestinal haemorrhage (AUGIH).
  
  
  METHODS
  All consecutive patients (n=1165) admitted for an AUGIH in four French administrative areas were entered into two separate 6-month studies conducted in 1996 (n=712) and 2000 (n=453). Epidemiological and biological characteristics, endoscopic haemostatic procedures and outcomes were compared.
  
  
  RESULTS
  Patient characteristics remained unchanged between the two studies; the two main bleeding lesions were peptic ulcer and oesophagogastric varices (30.2 versus 31.1% and 22.5 versus 20.3%). The use of non-steroidal anti-inflammatory drugs or aspirin was more frequent in 2000 (26.5 versus 32.6%; P<0.03). Proton pump inhibitor preventative therapy was administered in less than 15% of patients with a high risk of peptic ulcer bleeding in each period. In patients admitted for varices bleeding, the use of endoscopic haemostatic ligation increased (17.1 versus 40%; P<0.001), with a concomitant decrease in endoscopic sclerotic therapy (76.1 versus 37.5%; P<0.001). We observed a significant decrease in AUGIH mortality in the whole group (11.7 versus 7.2%; P=0.03), and particularly in the subgroup of cirrhotic patients (19.5 versus 11.1%; P=0.05) whatever the source of their bleeding.
  
  
  CONCLUSIONS
  Our time-trend evaluation of changes in AUGIH characteristics revealed that peptic ulcer and varices were still the two most frequent bleeding lesions. In patients with varices bleeding, endoscopic ligation became the routine standard treatment instead of varices sclerosis. The mortality rate decreased significantly over the 5-year study period in the whole group and particularly in the subgroup of cirrhotic patients.
authors.affiliation: Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Di Fiore
authors.forename: Stéphane
authors.initials: S
authors.lastname: Lecleire
authors.forename: Véronique
authors.initials: V
authors.lastname: Merle
authors.forename: Sophie
authors.initials: S
authors.lastname: Hervé
authors.forename: Christian
authors.initials: C
authors.lastname: Duhamel
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Dupas
authors.forename: Alain
authors.initials: A
authors.lastname: Vandewalle
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bental
authors.forename: Hervé
authors.initials: H
authors.lastname: Gouerou
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Le Page
authors.forename: Michel
authors.initials: M
authors.lastname: Amouretti
authors.forename: Pierre
authors.initials: P
authors.lastname: Czernichow
authors.forename: Eric
authors.initials: E
authors.lastname: Lerebours
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D015897:Comorbidity; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D005602:France / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin