title: Duodenal ulcers are a major cause of gastrointestinal bleeding after cardiac surgery.
abstract: To determine the incidence of gastrointestinal (GI) bleeding in patients after cardiac surgery, assess the perioperative risk factors, and determine the type of GI tract pathology associated with bleeding events.
  
  
  
  At a tertiary referral hospital, all cardiac surgery patients having a postoperative GI bleed from April 2002 to March 2012 were identified. To determine bleeding etiology, only patients requiring endoscopy were included in the analysis. By retrospective review of 3 prospectively maintained databases, the incidence and independent predictors of GI bleeding, as well as endoscopic findings, were determined.
  
  
  
  Ninety-one GI bleeding events that required endoscopy were identified in 9017 patients. Those that bled were aged 71 ± 12 years, and 76% were men. Sixty-three percent of these patients had valve surgery and 37% had an isolated coronary artery bypass grafting. The overall incidence of GI bleeding was 1.01%, with an upper GI source accounting for 78%. Endoscopy data found a duodenal ulcer as the bleeding source in 71%, whereas stress gastritis accounted for 8%. Preoperative risk factors for bleeding included age ≥70 years, ejection fraction <35%, congestive heart failure, cerebrovascular disease, chronic kidney disease, and gastrointestinal disease. A preoperative history of atrial fibrillation and anticoagulation with Coumadin also was associated with bleeding. Patients that bled had a 30-day mortality rate of 8.8%, which was significantly greater than patients who did not bleed (4.3%; P = .03).
  
  
  
  Clinical variables can be used to identify patients at high risk for GI bleeding after cardiac surgery. When GI bleeding occurs, the most common cause is duodenal ulceration, which has an association with Helicobacter pylori infection. These findings may provide an opportunity to initiate preoperative preventative strategies.
authors.affiliation: Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Frances
authors.initials: F
authors.lastname: Krawiec
authors.affiliation: Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Maitland
authors.affiliation: Statistical Support Unit, Centre for Advancement of Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Qiuli
authors.initials: Q
authors.lastname: Duan
authors.affiliation: Statistical Support Unit, Centre for Advancement of Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Faris
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Belletrutti
authors.affiliation: Libin Cardiovascular Institute of Alberta, Division of Cardiac Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada. Electronic address: william.kent@ahs.ca.
authors.forename: William D T
authors.initials: WDT
authors.lastname: Kent
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016208:Databases, Factual; D004381:Duodenal Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cardiac surgery; gastrointestinal hemorrhage; peptic ulcer disease