title: Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes.
abstract: OBJECTIVE
  To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).
  
  
  METHODS
  Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI.
  
  
  RESULTS
  The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers.
  
  
  CONCLUSIONS
  UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas.
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Quan
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Frolkis
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Kaylee
authors.initials: K
authors.lastname: Milne
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Molodecky
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Hong
authors.initials: H
authors.lastname: Yang
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Myers
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Hilsden
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Sander Veldhuyzen
authors.initials: SV
authors.lastname: van Zanten
authors.affiliation: Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Robert P Myers, Subrata Ghosh, Robert Hilsden, Gilaad G Kaplan, Departments of Medicine, University of Calgary, Calgary T2N-4N1, Alberta, Canada.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D016208:Databases, Factual; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D005260:Female; D006489:Hemostatic Techniques; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012423:Rural Health; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014504:Urban Health
keywords: Digestive system surgical procedures; Endoscopy; Epidemiology; Incidence; Mortality; Peptic ulcer hemorrhage; Validation studies