Nonvariceal upper gastrointestinal bleeding in Portugal: a multicentric retrospective study in twelve Portuguese hospitals.
BACKGROUND
Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with important mortality. More information is needed in order to improve NVUGIB management. The aims of this study were: (a) characterizing Portuguese patients and clinical approaches used in NVUGIB, (b) comparing management used in Portugal with management globally used in European countries, (c) identify factors associated with management options, and (d) identify factors associated with adverse outcome.


METHODS
ENERGiB was an observational, retrospective cohort study, on NVUGIB with endoscopic evaluation, carried across Europe. This study focuses on Portuguese patients of the ENERGiB study. Patients were managed according to routine care. Later, data were collected from files. Multivariate/univariate analyses were conducted on predictive factors of poor outcome and clinical decisions.


RESULTS
Patients (n=404) were mostly men (66.8%), mean age 68, with co-morbidities (72%), frequently on NSAIDs/aspirin. Most were assisted by general medical (57.8%) or surgical team (20.6%), only 19.4% by gastroenterology/GI-bleeding team. PPI was largely used. Gastric/duodenal ulcers, erosive gastritis and esophagitis were the main bleeding causes. 10% had bleeding persistence/recurrence. Death occurred in 24 patients, 20 from a non-bleeding related cause. Poor outcomes were related with age >65, co-morbidities, fresh blood haematemesis, shock/syncope, bleeding through previous nasogastric tube, massive fluid replacement or transfusions besides erythrocytes.


CONCLUSIONS
This study contributed to characterization of Portuguese patients and NVUGIB episodes in real clinical setting and identified factors associated with a poor outcome. It also identified differences, especially in the organization of GI bleeding teams, which might help us to improve the management of these patients.
Gastroenterology Department, Hospital Garcia de Orta, Almada, Portugal. jorgedafonseca@hotmail.com
Jorge
J
Fonseca
Carlos C
CC
Alves
Rosa
R
Neto
Bruno
B
Arroja
Rosário
R
Vidal
Guilherme
G
Macedo
Ana A
AA
Nunes
Ana
A
Rego
Joao
J
Carvalho
António
A
Banhudo
António
A
Curado
Paula N
PN
Lima
Joao
J
Baranda
Filipe
F
Ribeiro
D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D019468:Disease Management; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D004945:Esophagoscopy / Q000009:adverse effects; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy; D006396:Hematemesis / Q000453:epidemiology; D016558:Hemostasis, Endoscopic / Q000706:statistics & numerical data; D006488:Hemostasis, Surgical / Q000706:statistics & numerical data; D006489:Hemostatic Techniques / Q000706:statistics & numerical data*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008551:Melena / Q000453:epidemiology; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000706:statistics & numerical data; D012771:Shock, Hemorrhagic / Q000453:epidemiology; D016896:Treatment Outcome