Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting

Abstract

Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age- and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB. Results. A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004). Conclusions. LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.

Key Words::

• anti-inflammatory agents
• gastrointestinal hemorrhage
• hematemesis
• low-dose aspirin
• melena
• non-steroidal

Acknowledgements

The authors would like to thank Magdalena Sigurðardottir RN, Elisabet Lilja Haraldsdottir secretary and the doctors and nurses at the Endoscopic Department at the National University Hospital of Iceland. The authors would also like to thank Runar Gudlaugsson Msc.pharm. at the Icelandic Medicines Agency. This study was supported with a grant from the National University Hospital of Iceland Research Fund.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.