Effects of seasonal variations on acute upper gastrointestinal bleeding and its etiology.
OBJECTIVE
The aim of this study was to determine the causes and risk factors of acute upper gastrointestinal bleeding, a frequently encountered medical emergency, and to determine any relation in its frequency according to month or season.


METHODS
We evaluated the records of 336 patients who presented to our hospital with acute upper gastrointestinal bleeding between October 2001 and June 2005. Three hundred and sixteen patients had endoscopy within 12-24 hours of admission. Causes of bleeding, risk factors, drug usage and admission dates were documented, any relations with season or month of occurrence were determined and statistical analyses were made.


RESULTS
Two hundred and thirty-seven patients were male (70.5%) and 99 patients female (29.5%), with an average age of 57.7 years. The most frequent endoscopic findings were peptic ulcer (48.2%) and esophageal (or gastric) variceal bleeding (22%) in all seasons and months except September. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most common risk factor (44.3%) and the risk of acute gastrointestinal bleedings was high in all seasons and months except October. March (14%) and spring (33.6%) were the month/season when bleeding was the most frequent. There was a gradual increase in the number of patients admitted with bleeding from autumn to spring. Furthermore, NSAID usage, which was the most frequent risk factor, showed a monthly fluctuation similar to the fluctuation in the total number of bleeding patients.


CONCLUSIONS
In the province of Mersin, Turkey, the most common cause of acute upper gastrointestinal bleeding is peptic ulcer, and NSAID usage is the most frequent etiological risk factor. Although statistically insignificant, there were seasonal and monthly fluctuations in upper gastrointestinal bleedings in Mersin, where the Mediterranean climate is predominant. Bleeding was the most frequent in March and spring and the least frequent in September and autumn. Bleedings showed a seasonal fluctuation similar to that of NSAID usage, which was the most frequent risk factor. Therefore, if unnecessary NSAID usage can be prevented, it may be possible to protect most people against this emergency condition, which can be lethal, in all months and seasons.
Sezgin
Orhan
O
Department of Gastroenterology, Mersin University, School of Medicine, Mersin. sezginorhan@ttnet.net.tr
Altintaş
Engin
E
Tombak
Anil
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000453:epidemiology; D005260:Female; D005756:Gastritis / Q000150:complications / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology; D010437:Peptic Ulcer / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D012621:Seasons; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal