ObjectivesIn recent years, policies have been proposed in order to guide the safer use of non-steroidal anti-inflammatory drugs (NSAIDs) and antiulcer therapy. We aimed to investigate the incidence of upper gastrointestinal bleeding (UGIB) before and after the introduction of these policies, 2007–2009, in a well-defined population in southwest Scotland.MethodsAll patients with non-variceal upper gastrointestinal bleeding (NV-UGIB), diagnosed at a single regional unit, were included. Total drugs prescribed in our population were noted, including antiulcer drugs, antithrombotic drugs and both cyclo-oxygenase-2 enzyme-selective and non-selective inhibiting NSAIDs.ResultsThe incidence, the number of cases per 100 000 population per annum, of NV-UGIB fell from 134.7 in 2007 to 125.1 in 2008, and to 90.3 cases in 2009 (p<0.001). There was also a significant rise in the use of non-selective NSAIDs, proton pump inhibitors and antithrombotic drugs.ConclusionsAlthough a cause-and-effect relationship cannot be fully proven, physician education through drug-use policies is associated with a drop in the incidence of NV-UGIB. This is relevant to the prevention of this common condition.

Introduction Blood transfusion is integral to the management of non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being questioned in less severe cases. We, therefore aimed to measure 30-day and 2-year mortality after blood transfusion for NV-UGIB. Methods This was an observational analysis using routinely collected data at a single hospital in southwest Scotland affi liated to Glasgow University. Cox proportional hazards models were used to estimate the effect of blood transfusion on mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute upper gastrointestinal bleeding, admission status, drug intake, etc. The main outcome measure was death of any cause at 30 days and 2 years after NV-UGIB. Results 1340 patients presented with NV-UGIB, 808 males (60.3%), median age 67 years and 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 25.8% at 2 years regardless of transfusion. Mortality was higher in the transfused versus non-transfused patients (P < 0.001, log rank test), as shown in fi gure 1. Also, in patients with a haemoglobin level greater than 10.0 g/dl, and comparing subjects who were transfused with those who were not, 30-day mortality (95% confi dence intervals) was 11.5% (6.7-18.0) versus 3.6% (2.3-5.3), respectively, P < 0.001; and 2-year mortality (95% confi dence intervals) was 40% (32-49) versus 20% (17-23), P < 0.001. Adjusted for age, Charlson score, Rockall score and

ObjectivesThe understanding of changes in comorbidity might improve the management of upper gastrointestinal bleeding (UGIB); such changes might not be detectable in short-term studies. We aimed to study UGIB mortality as adjusted for comorbidity and the trends in risk scores over a 14-year period.MethodsPatients presenting with UGIB to a single institution, 1996–2010, were assessed. Those with multiple comorbidities were managed in a multi-disciplinary care unit since 2000. Trends with time were assessed using logistic regression, including those for Charlson comorbidity score, the complete Rockall score and 30-day mortality.Results2669 patients were included. The Charlson comorbidity score increased significantly with time: the odds of a high (3+) score increasing at a relative rate of 4.4% a year (OR 1.044; p<0.001). The overall 30-day mortality was 4.9% and inpatient mortality was 7.1%; these showed no relationship with time. When adjusted for the increasing comorbidity, the odds of death decreased significantly at a relative rate of 4.5% per year (p=0.038). After the introduction of multi-disciplinary care, the raw mortality OR was 0.680 (p=0.08), and adjusted for comorbidity it was 0.566 (p=0.013).Conclusions30-day mortality decreased when adjusted for the rising comorbidity in UGIB; whether this is related to the introduction of multi-disciplinary care needs to be considered.

SUMMARY BackgroundWhile 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 Blood transfusion remains an integral step in the management of acute non-variceal upper gastrointestinal bleeding (NV-UGIB), but its safety is being increasingly questioned in less severe cases. The authors aimed to measure 30-day and 2-year mortalities after blood transfusion for NV-UGIB. Methods Cox proportional hazards models were used to estimate the association of blood transfusion with mortality while adjusting for age, Charlson comorbidity score, the complete Rockall score for acute UGIB, admission status and medication intake prior to bleeding. Main outcome measures Death from any cause at 30 days and 2 years after NV-UGIB. Results 1340 patients presented with NV-UGIB (808 men (60.3%), median age 67 years) of whom 564 (42.1%) were transfused. The overall mortality was 5.3% at 30 days and 26.0% at 2 years in all patients. Comparing subjects with a haemoglobin concentration greater than 10.0 g/dl who were transfused with those who were not, 30-day mortalities (95% CIs) were 11.5% (6.7 to 18.0) versus 3.6% (2.3 to 5.3), respectively, p<0.001, and 2-year mortalities (95% CIs) were 40% (32 to 49) versus 20% (17 to 23), p<0.001. After adjusting for age, Charlson score, Rockall score and haemoglobin, the HRs (95% CIs) for death after transfusion were 1.88 (1.00 to 3.55) (p=0.051) at 30 days and 1.71 (1.28 to 2.28), (p<0.001) at 2 years. Conclusion In patients with moderately severe NV-UGIB, mortality is higher following blood transfusion. Whether this refl ects selection bias, an effect of comorbidity or an effect of transfusion requires urgent prospective study.