Gastrointestinal Bleeding

Abstract

Epidemiology, Risk Factors, and OutcomesA trend toward a lower relative frequency of peptic ulcer disease (PUD) as the cause of upper gastrointestinal bleeding has been observed in recent years. A multicenter study in the United States confirmed this tendency, comparing data from the last 3 years with historical controls from the years 1983 ± 1992. The frequency of PUD decreased significantly from 59 % to 38 %. Effective antisecretory drugs, Helicobacter pylori eradication treatment, and newer nonsteroidal anti-inflammatory drugs (NSAIDs) are all probably responsible for this decline. The frequency of variceal bleeding increased to a lesser extent, but also significantly, from 12 % to 16 %. Probably the most striking finding was an increase in the frequency of erosive esophagitis, from 4.3 % to 12.9 %; the authors were not able to explain this increase. The frequencies of other causes remained at a similar level to that seen before, except for gastric/duodenal erosions (with a decline from 4.4 % to 1.7 %) and Dieulafoy's lesions (with an increase from 0.6 % to 2.3 %); however, these changes were not significant. A significant improvement in almost all outcome measures (rebleeding, surgery, and death rates) in all groups of patients (PUD, varices, others) was observed in the recent period in comparison with the decade 1983±1992 [1].