Changing Epidemiology and Etiology of Upper Gastrointestinal Bleeding

Upper gastrointestinal bleeding (UGIB) is defined as bleeding from the esophagus, stomach, and duodenum, whereas lower gastrointestinal bleeding originates from below the ligament of Treitz, including the small bowel and colon. The incidence of UGIB has decreased globally over the past 20 years, reaching approximately 50-150 and 47 cases per 100,000 of the global population per year for variceal and non-variceal bleeding, respectively. The eradication of Helicobacter pylori and the widespread introduction of proton pump inhibitors have contributed to the current improvement in epidemiological outcomes. Regarding the etiology of UGIB, peptic ulcer disease is the most common cause, accounting for 43.6% of cases, followed by gastritis and duodenitis (27.6%), esophageal variceal bleeding (8.0%), and esophagitis (5.6%). Other causes, including malignancy, Dieulafoy's lesions, and Mallory Weiss tears, collectively account for 10-12% of UGIB. In conclusion, the outcomes of H. pylori eradication and the widespread introduction of proton pump inhibitors have offset the effects of an aging population. In addition, the increasing indications for non-steroidal anti-inflammatory drugs, anticoagulation, and antiplatelet agents have resulted in a decrease in the incidence of UGIB.