title: Occult vs. overt upper gastrointestinal bleeding - inverse relationship and the use of mucosal damaging and protective drugs.
abstract: BACKGROUND
  While efforts have focused on the prevention of overt upper gastrointestinal bleeding (UGIB), little is known about occult GIB, which might also originate from sites not protected by acid inhibition.
  
  
  OBJECTIVE
  To measure the incidence and outcomes of both overt and occult GIB over a 6-year period (2007-2012), and to assess the use of NSAIDs, anti-thrombotic therapy (ATT), proton pump inhibitors (PPIs), and iron therapy.
  
  
  METHODS
  A sample of 300 patients (100 from each of three index years) with occult GIB was randomly selected and their outcomes were compared with those of patients with overt UGIB (N = 869).
  
  
  RESULTS
  The incidence of overt UGIB fell from 140.1 per 100 000 population per annum in 2007 to 106.8 in 2010 and to 88.0 in 2012 (P < 0.001); while that of occult GIB rose from 243.1 to 263.6 and to 292.8 (P < 0.001) over the same period. The incidence of occult GIB was highly correlated with the number of prescriptions of PPIs per 1000 population (χ(2) trend = 11.80; P < 0.001). In the overt UGIB group, the median haemoglobin level on presentation was lowest (10.3) in patients taking NSAIDs/ATT plus PPIs compared with those taking PPIs alone (11.5), NSAIDs/ATT alone (10.4) or none of these drugs (12.7 g/dL) (P < 0.001, Kruskal-Wallis).
  
  
  CONCLUSIONS
  An inverse trend seems to have formed in the incidence of overt vs. occult gastrointestinal bleeding in association with the wider use of PPIs and NSAIDs. An alternative approach to acid inhibition is needed to prevent gastrointestinal bleeding.
authors.affiliation: Gastroenterology, University Hospital Crosshouse, Kilmarnock, UK.|Kilmarnock and the School of Medicine, University of Glasgow, Glasgow, UK.
authors.forename: A S
authors.initials: AS
authors.lastname: Taha
authors.affiliation: Gastroenterology, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: C
authors.initials: C
authors.lastname: McCloskey
authors.affiliation: Gastroenterology, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: T
authors.initials: T
authors.lastname: Craigen
authors.affiliation: Gastroenterology, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: A
authors.initials: A
authors.lastname: Simpson
authors.affiliation: Kilmarnock and the School of Medicine, University of Glasgow, Glasgow, UK.
authors.forename: W J
authors.initials: WJ
authors.lastname: Angerson
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D020011:Protective Agents / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D020011:Protective Agents; D054328:Proton Pump Inhibitors