Acute upper gastrointestinal bleeding in the UK: 2022 audit update

Area of Science:

• Gastroenterology
• Internal Medicine
• Clinical Auditing

Background:

• Acute upper gastrointestinal bleeding (AUGIB) presents a significant medical emergency.
• Management strategies, including medical/endoscopic therapy and transfusion protocols, are continually evolving.
• Recent UK audits provide critical data on current AUGIB demographics and treatment approaches.

Purpose of the Study:

• To present key findings from the 2022 UK audit of AUGIB.
• To compare the 2022 data with the preceding 2007 audit findings.
• To identify trends and evaluate changes in AUGIB management and outcomes over time.

Main Methods:

• A prospective, multicentre audit involving 147 UK hospitals.
• Data collected from adult patients (≥16 years) with AUGIB between May and July 2022.
• Patient outcomes tracked until discharge, death, or 28 days, with re-admissions counted as new episodes.

Main Results:

• The 2022 cohort (5141 patients) exhibited higher comorbidity (67%), cirrhosis (15%), and anticoagulant use (31%) compared to 2007.
• Peptic ulcer disease (32%) and no abnormality (33%) were common causes; 42% lacked pre-endoscopic risk stratification.
• Despite increased risk factors, outcomes improved: rebleeding decreased to 9.7%, in-hospital mortality to 8.8%, and median stay to 5 days.
• Liberal transfusion (Hb >70 g/L) in stable patients was linked to increased mortality (aOR 1.60 at 80 g/L).

Conclusions:

• AUGIB outcomes have improved despite a higher-risk patient profile and suboptimal guideline adherence.
• Restrictive transfusion strategies, especially avoiding liberal transfusions above 80 g/L in stable patients, are vital.
• Quality improvement initiatives focusing on risk stratification, endoscopic training, and multidisciplinary care are recommended to further improve outcomes.