OTU-06 Upper gastrointestinal bleeding in scotland: trends in demographics and outcomes 2000–2015

Chaudhary, Sardar; Mackay, Daniel; Pell, Jill P.; Morris, Allan J.; Church, Nick; Fraser, Andrew; Stanley, Adrian

doi:10.1136/gutjnl-2019-bsgabstracts.6

Cited by 4 publications

(5 citation statements)

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“…This variability in mortality rates reported is almost certainly a result of the examination of heterogeneous populations, site of study, methods of recruitment, local practices and so on. The data from this study represent a diverse population and are consistent with several recent studies, which have shown decreases in mortality due to upper GI bleeding 4,32 . Notwithstanding, two conclusions appear to be precise.…”

Section: Discussionsupporting

confidence: 90%

The impact of red blood cell transfusion practices on inpatient mortality in variceal and non‐variceal gastrointestinal bleeding patients: a 20‐year US nationwide retrospective analysis

Radadiya

Devani

2022

Aliment Pharmacol Ther

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Summary Background Previous studies in upper gastrointestinal (GI) bleeding have reported inconsistent outcomes about packed red blood cell (PRBC) transfusion practices. Aim To assess whether PRBC transfusion is more likely to be dangerous in variceal bleeding than in non‐variceal bleeding due to concern of over‐transfusion leading to elevated portal pressure. Methods We used the Nationwide Inpatient Sample (1999–2018). We identified patients with upper GI bleeding using an algorithmic approach, categorising bleeding from non‐variceal or variceal sources. Our primary outcome was all‐cause inpatient mortality. To control for the severity of bleeding, we performed propensity matching of baseline features, including age, gender, the presence of shock, the need for ICU care and co‐morbidities. We also examined PRBC transfusion, inpatient mortality and hospitalisation rates for both populations. Results We included 10,228,524 upper GI bleeding discharges; 755,135 patients had variceal bleeding. After propensity matching, PRBC transfusion in variceal bleeders was associated with a 22% increase in inpatient mortality, whereas non‐variceal bleeders had a 9% increase in inpatient mortality. Compared to non‐variceal bleeders receiving blood transfusion, variceal bleeders had nearly four‐fold higher odds of inpatient mortality (propensity‐matched OR: 3.8; 95% CI: 3.7–3.8; p < 0.001). Notably, PRBC transfusion rates in both groups have declined since 2011, although it has remained higher in variceal bleeders. Mortality for upper GI bleeding has been declining since 1999. Conclusions Although decreased over the last decade, PRBC transfusion rates remain high for variceal bleeders. In addition, PRBC transfusion appears to be more detrimental in variceal bleeders than in non‐variceal bleeders.

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Section: Discussionsupporting

confidence: 90%

The impact of red blood cell transfusion practices on inpatient mortality in variceal and non‐variceal gastrointestinal bleeding patients: a 20‐year US nationwide retrospective analysis

Radadiya

Devani

2022

Aliment Pharmacol Ther

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“…[7][8][9] Improved management, including resuscitation, proton pump inhibitor use, and endoscopic treatments have been associated with the reported reduction in mortality from UGIB over the past two decades. 10 However, patients presenting with UGIB are increasingly of an older age with substantial comorbidities including cardiac, vascular, and renal disease, and use of antiplatelet or anticoagulant drug is common. This demographic could account for the static mortality reported by some studies.…”

Section: Incidencementioning

confidence: 99%

Update on the management of upper gastrointestinal bleeding

Orpen-Palmer

Stanley

2022

bmjmed

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Upper gastrointestinal bleeding is a common emergency presentation requiring prompt resuscitation and management. Peptic ulcers are the most common cause of the condition. Thorough initial management with a structured approach is vital with appropriate intravenous fluid resuscitation and use of a restrictive transfusion threshold of 7-8 g/dL. Pre-endoscopic scoring tools enable identification of patients at high risk and at very low risk who might benefit from specific management. Endoscopy should be carried out within 24 h of presentation for patients admitted to hospital, although optimal timing for patients at a higher risk within this period is less clear. Endoscopic treatment of high risk lesions and use of subsequent high dose proton pump inhibitors is a cornerstone of non-variceal bleeding management. Variceal haemorrhage results in higher mortality than non-variceal haemorrhage and, if suspected, antibiotics and vasopressors should be administered urgently, before endoscopy. Oesophageal variceal bleeding requires endoscopic band ligation, whereas bleeding from gastric varices requires thrombin or tissue glue injection. Recurrent bleeding is managed by repeat endoscopic treatment. If uncontrolled bleeding occurs, interventional radiological embolisation or surgery is required for non-variceal bleeding or transjugular intrahepatic portosystemic shunt placement for variceal bleeding.

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“…We thank Dr Adu-Tei and colleagues for their interest in our article and their work on improving standards and quality of endoscopy training in upper GI bleeding (UGIB). 1,2 We are also encouraged by the results of their review assessing outcomes for patients presenting with UGIB where trainees undertook the procedure. Unfortunately, in our study we did not have access to the data required to allow us to assess the impact of trainee involvement in endoscopy for UGIB.…”

Section: Letter: Enhancing Training Opportunities For Upper Gi Bleeding In Sheffield -A Uk Transferable Model? Authors' Replymentioning

confidence: 99%

“…We thank Dr Adu‐Tei and colleagues for their interest in our article and their work on improving standards and quality of endoscopy training in upper GI bleeding (UGIB) 1,2 . We are also encouraged by the results of their review assessing outcomes for patients presenting with UGIB where trainees undertook the procedure.…”

mentioning

confidence: 99%

Letter: enhancing training opportunities for upper GI bleeding in Sheffield ‐ a UK transferable model? Authors' reply

Chaudhary

Stanley

2021

Aliment Pharmacol Ther

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OTU-06 Upper gastrointestinal bleeding in scotland: trends in demographics and outcomes 2000–2015

Cited by 4 publications

References 0 publications

The impact of red blood cell transfusion practices on inpatient mortality in variceal and non‐variceal gastrointestinal bleeding patients: a 20‐year US nationwide retrospective analysis

The impact of red blood cell transfusion practices on inpatient mortality in variceal and non‐variceal gastrointestinal bleeding patients: a 20‐year US nationwide retrospective analysis

Update on the management of upper gastrointestinal bleeding

Letter: enhancing training opportunities for upper GI bleeding in Sheffield ‐ a UK transferable model? Authors' reply

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