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National trends in hospitalizations for gastrointestinal bleeding in Japan
Chikamasa Ichita1,2, Tadahiro Goto3,4,2, Akiko Sasaki1
1Gastroenterology Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa 247-8533, Japan.
Insights
Gastrointestinal bleeding (GIB) hospitalization trends in Japan show a significant shift. Upper GIB rates declined, while lower GIB, including colonic diverticular bleeding and ischemic colitis, increased substantially.
Area of Science:
- Gastroenterology
- Public Health
- Epidemiology
Background:
- Gastrointestinal bleeding (GIB) is a major cause of morbidity.
- Nationwide data on GIB trends in Japan were previously unavailable.
- Understanding these trends is crucial for effective healthcare management.
Purpose of the Study:
- To analyze national data on GIB hospitalization trends in Japan from 2012 to 2019.
- To identify shifts in the types of GIB requiring hospitalization.
- To inform clinical focus and resource allocation for GIB management.
Main Methods:
- Analysis of Japan's National Database sampling data (2012-2019).
- Evaluation of annual hospitalization rates for six major GIB types.
- Comparison of rates for hemorrhagic gastric ulcers, duodenal ulcers, esophageal variceal bleeding, colonic diverticular bleeding, ischemic colitis, and rectal ulcers.
Main Results:
- Hospitalization rates for hemorrhagic gastric ulcers significantly decreased.
- Rates for colonic diverticular bleeding more than doubled.
- Ischemic colitis rates increased 1.6-fold.
- By 2017, lower GIB (colonic diverticular bleeding, ischemic colitis) surpassed upper GIB (hemorrhagic gastric ulcers) in hospitalization rates.
- No significant changes were observed for duodenal ulcers, esophageal variceal bleeding, or rectal ulcers.
Conclusions:
- A notable shift in GIB hospitalizations from upper to lower gastrointestinal sources occurred by 2017.
- This trend suggests a potential change in clinical priorities and resource allocation needs.
- Further research into the causes and implications of this shift is warranted.
Abstract:
Gastrointestinal bleeding (GIB) is a significant public health concern, predominantly associated with high morbidity. However, there have been no reports investigating the trends of GIB in Japan using nationwide data. This study aims to identify current trends and issues in the management of GIB by assessing Japan's national data. We analyzed National Database sampling data from 2012 to 2019, evaluating annual hospitalization rates for major six types of GIB including hemorrhagic gastric ulcers, duodenal ulcers, esophageal variceal bleeding, colonic diverticular bleeding, ischemic colitis, and rectal ulcers. In this study, hospitalization rates per 100,000 indicated a marked decline in hemorrhagic gastric ulcers, approximately two-thirds from 41.5 to 27.9, whereas rates for colonic diverticular bleeding more than doubled, escalating from 15.1 to 34.0. Ischemic colitis rates increased 1.6 times, from 20.8 to 34.9. In 2017, the hospitalization rate per 100,000 for colonic diverticular bleeding and ischemic colitis surpassed those for hemorrhagic gastric ulcers (31.1, 31.3, and 31.0, respectively). No significant changes were observed for duodenal ulcers, esophageal variceal bleeding, or rectal ulcers. The findings of this study underscore a pivotal shift in hospitalization frequencies from upper GIB to lower GIB in 2017, indicating a potential shift in clinical focus and resource allocation.
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