Why Do Mortality Rates for Nonvariceal Upper Gastrointestinal Bleeding Differ around the World? A Systematic Review of Cohort Studies

Jairath, Vipul; Martel, Myriam; Logan, Richard F.; Barkun, Alan N.

doi:10.1155/2012/862905

Cited by 47 publications

(26 citation statements)

References 69 publications

(82 reference statements)

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“…This was to catch the patients missed to active inclusion and to make sure that the data were as reliable as possible in regard to true incidence rate and mortality. Most studies use database reviews or retrospective cohort designs based on ICD10 codes to execute epidemiological studies [19,[22][23][24][25]. This might increase the risk of misclassification of diagnosis for peptic ulcer bleeding and missing data.…”

Section: Discussionmentioning

confidence: 99%

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Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Romstad

Detlie

Søberg

et al. 2020

Scandinavian Journal of Gastroenterology

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Objectives: Acute upper gastrointestinal bleeding is a well-recognized complication of peptic ulcers and erosions. The aim of this study was to assess the incidence rate and identify risk factors for this complication in southeastern Norway. Materials and methods: Between March 2015 and December 2017, a prospective observational study was conducted at two Norwegian hospitals with a total catchment area of approximately 800,000 inhabitants. Information regarding patient characteristics, comorbidities, drug use, H. pylori status and 30-day mortality was recorded. Results: A total of 543 adult patients were included. The incidence was 30/100,000 inhabitants per year. Altogether, 434 (80%) of the study patients used risk medication. Only 46 patients (8.5%) used proton pump inhibitors (PPIs) for more than 2 weeks before the bleeding episode. H. pylori testing was performed in 527 (97%) patients, of whom 195 (37%) were H. pylori-positive. The main comorbidity was cardiovascular disease. Gastric and duodenal ulcers were found in 183 (34%) and 275 (51%) patients, respectively. Simultaneous ulcerations at both locations were present in 58 (10%) patients, and 27 (5%) had only erosions. Overall, the 30-day mortality rate was 7.6%. Conclusions: The incidence of upper gastrointestinal bleeding due to peptic ulcers and erosions was found to be lower than previously demonstrated in comparable studies, but the overall mortality rate was unchanged. The consumption of risk medication was high, and only a few patients had used prophylactic PPIs. Concurrent H. pylori infection was present in only one-third of the patients. Clinical trial registration: Bleeding Ulcer and Erosions Study 'BLUE Study', ClinicalTrials.gov Identifier. NCT03367897.

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, bleeding from a peptic ulcer is a serious complication, and a mortality rate of up to 10% has previously been reported, despite advances in medical and endoscopic treatment [1,24,25].…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Romstad

Detlie

Søberg

et al. 2020

Scandinavian Journal of Gastroenterology

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“…Meanwhile, patients with peptic ulcer also accounted for a higher proportion. Jairath [ 32 ] reported that the greater difference in the mortality rates of NVUGIB reported worldwide was mainly due to the different research methods and populations in the studies. Multivariate studies found that age ≥80 years, admission to the emergency ward, systolic blood pressure of 50 mmHg, the presence of 2 or more comorbidities, and re-bleeding led to a significant increase in the mortality risk, while emergency endoscopy can reduce the rate of mortality.…”

Section: Discussionmentioning

confidence: 99%

Peptic Ulcer Is the Most Common Cause of Non-Variceal Upper-Gastrointestinal Bleeding (NVUGIB) in China

Lü

Zhang

et al. 2018

Med Sci Monit

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BackgroundThis study aimed to discover the common cause of non-variceal upper-gastrointestinal bleeding (NVUGIB) by conducting a multi-center retrospective study from 2008 to 2012.Material/MethodsHospitalized patients ages ≥18 years old, from 8 hospitals in China, diagnosed with NVUGIB by endoscopy from 1 January 2008 to 31 December 2012 were enrolled. Questionnaires were developed and a data-entry graphical user interface was designed by using EpiData software.ResultsTotal of 2977 hospitalized patients from 8 medical centers were included. A total of 95.47% (2842/2977) of patients were admitted to a general ward, 3.53% (105/2977) were admitted to an emergency ward, and 1.00% (31/2977) were admitted to an intensive care unit. Peptic ulcer remained the most common cause of NVUGIB (73.26%), but there was a declining trend in its constituent ratio, from 2008 to 2012. A total of 14.41% (429/2977) of patients had co-morbid conditions, 92.85% (2764/2977) used proton-pump inhibitors (PPIs) prior to endoscopic treatment, 19.65% (585/2977) underwent emergency endoscopy, and 23.45% (698/2977) received a transfusion of red blood cell suspensions. A total of 5.34% (159/2977) underwent endoscopic therapy, with a treatment rate of 16.9% in high-risk peptic ulcer patients (96/568). A total of 7.69% (237/2977) were administered aspirin, of whom 32.50% (77/237) resumed aspirin intake after gastrointestinal bleeding was controlled. The median length of hospitalization was 8 days (IQR, 5–11) and the mortality rate was 1.71% (51/2977).ConclusionsPeptic ulcer was still the most common cause of NVUGIB in China. The proportion of patients with high-risk peptic ulcer bleeding who received endoscopic therapy was 16.9%. Only 19.65% of NVUGIB patients underwent emergency endoscopy.

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“…The low mortality rate in our cohort is within the range of mortality rates in elderly patients with nonvariceal upper GIB reported in prior studies [ 1 – 3 , 7 ]. Prior studies on nonvariceal upper GIB in the general population had wide variation in mortality which is believed to be related to the definition of upper GIB and the populations studied [ 16 ]. We chose to define UGIB based on endoscopic findings rather than using presenting symptoms if other than hematemesis.…”

Section: Discussionmentioning

confidence: 99%

Blatchford Score Is Superior to AIMS65 Score in Predicting the Need for Clinical Interventions in Elderly Patients with Nonvariceal Upper Gastrointestinal Bleed

Abusaada

Rahman

Pech

et al. 2016

Advances in Medicine

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Background. Blatchford and AIMS65 scores were developed to risk stratify patients with upper gastrointestinal bleed (UGIB). We sought to assess the performance of Blatchford and AIMS65 scores in predicting outcomes in elderly patients with nonvariceal UGIB. Methods. A retrospective cohort study of elderly patients (over 65 years of age) with nonvariceal UGIB admitted to a tertiary care center. Primary outcome was a combined outcome of in-hospital mortality, need for any therapeutic endoscopic, radiologic, or surgical intervention, rebleeding within 30 days, or blood transfusion. Secondary outcome was a combined outcome of in-hospital mortality or need for an intervention to control the bleed. Results. 164 patients were included. The primary outcome occurred in 119 (72.5%) patients. The secondary outcome occurred in 12 patients (7.2%). Blatchford score was superior to AIMS65 score in predicting the primary outcome (area under the receiver-operator curve (AUROC) 0.84 versus 0.68, resp., p < 0.001). Both scores performed poorly in predicting the secondary outcome (AUROC 0.56 versus 0.52, resp., p = 0.18). Conclusions. Blatchford score could be useful in predicting the need for hospital based interventions in elderly patients with nonvariceal UGIB. Blatchford and AIMS65 scores are poor predictors of the need for a therapeutic intervention to control bleeding.

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Why Do Mortality Rates for Nonvariceal Upper Gastrointestinal Bleeding Differ around the World? A Systematic Review of Cohort Studies

Cited by 47 publications

References 69 publications

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Gastrointestinal bleeding due to peptic ulcers and erosions – a prospective observational study (BLUE study)

Peptic Ulcer Is the Most Common Cause of Non-Variceal Upper-Gastrointestinal Bleeding (NVUGIB) in China

Blatchford Score Is Superior to AIMS65 Score in Predicting the Need for Clinical Interventions in Elderly Patients with Nonvariceal Upper Gastrointestinal Bleed

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