Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study

Abstract

SUMMARY BackgroundUpper gastrointestinal (GI) bleeding is the most common emergency managed by gastroenterologists.

Epidemiology of Upper Gastrointestinal Bleeding

“…A small study of less than 2000 patients from the north west of Scotland demonstrated a 2 fold difference in the occurrence of upper gastrointestinal haemorrhage between the least and most deprived, while a recent report from Wales also indicated that those from most deprived areas have the highest rate of hospitalization for upper gastrointestinal haemorrhage. 22,25 However both these studies found higher hospitalisation rates than previous studies and this raises questions of how their popu-CHAPTER 2: BACKGROUND: Occurrence and trends lations and cases were defined. Furthermore both studies only reported crude combined variceal and non variceal haemorrhage estimates and their methodology and limited size mean they did not investigate whether differences in age, gender, year or region might be responsible for the socioeconomic gradient.…”

“…35 Regional incidence within one country can also vary widely. The incidence in north west Scotland has been estimated to be 172/100,000, 22 the incidence in Wales has been estimated to be 134/100,000, 25 and the incidence in middle England has been estimated to be between 43/100,000 around Oxford 36 to 103/100,000 around the Thames and the Midlands. 23 The reason for these large regional differences within the UK is often thought to be deprivation.…”

“…However mortality in longitudinal population cohorts of upper gastrointestinal bleeds remains unchanged at about 10-14%. 3,25 Increasing age and co-morbidity confounding the effects of therapy improvements have been proposed as the likely explanation. 60 The consistent tendency noted at the start of the last century for co-morbidity and advanced age to predict worse short term outcomes has been extended by a number of authors to develop risk stratification strategies to aid in selecting the appropriate level of care.…”

“…114 It is possible likewise that smoking to some extent mediates a steep socio-economic gradient long shown to exist for peptic ulcer disease 115 and more recently for upper gastrointestinal haemorrhage also. 22,25 Differences in prescribing practices, alcohol consumption or Helicobacter pylori prevalence may also contribute to this gradient. Finally high altitudes are associated with an increased incidence of gastrointestinal haemorrhage among migrant workers, 116 as well as among acclimatised people.…”

BLEEDING AND STARVING: fasting and delayed refeeding after upper gastrointestinal bleeding

“…The Nonvariceal Upper Gastrointestinal Bleeding (NVUGIB) is a frequent cause for hospitalization (4,6,8,11,14,17,20) . Recent clinical studies demonstrate that the outcome of these patients can be improved when clinical resources are improved, decreasing the recurrence of bleeding (2,13,15,19) , the need for transfusion (13,19) and surgery (13) and reducing the length of stay and hospital costs (13,19) .…”