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Upper gastrointestinal hemorrhage: have new therapeutics made a difference?
Chad T Whelan1, Peter Kaboli, Qi Zhang
1Department of Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA. cwhelan@uchicago.edu
Journal of Hospital Medicine
|September 16, 2009
Summary
Upper gastrointestinal hemorrhage (UGH) is most commonly caused by esophageal disease (ED), not peptic ulcer disease (PUD). Most patients had UGH risk factors, highlighting a need for better preventive therapies.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Epidemiology
Background:
- Upper gastrointestinal hemorrhage (UGH) is a significant clinical concern.
- New pharmacologic therapies may influence the incidence and risk factors of UGH.
Purpose of the Study:
- To investigate the distribution of causes and risk factors for UGH.
- To assess the impact of evolving pharmacologic treatments on UGH epidemiology.
Main Methods:
- Retrospective analysis of 227 UGH inpatients across two academic medical centers (July 2001-June 2003).
- Data collection included demographics, UGH risk factors, and etiologies via administrative data and chart review.
- Bivariate and multivariate analyses were employed to examine distributions and associations.
Main Results:
- Esophageal disease (ED) was the leading cause of UGH (44%), followed by peptic ulcer disease (PUD) (33%) and variceal bleeds (17%).
- Common risk factors included prior UGH (43%), NSAID use (23%), and aspirin (ASA) use (25%).
- Significant site-specific differences in UGH etiology were observed, with ED more prevalent at one site.
Conclusions:
- PUD is no longer the most common UGH etiology, suggesting successful H. pylori eradication strategies.
- Esophageal disease remains the primary cause of UGH despite advances in acid suppression therapy.
- A majority of patients presented with risk factors for UGH, yet many were not on preventive medications, indicating a gap in care.
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