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Causes and outcome of upper and lower gastrointestinal bleeding: the Grady Hospital experience
1Department of Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
Insights
Gastrointestinal bleeding causes are consistent over decades. This study found low surgical intervention and mortality rates for both upper and lower GI bleeding, despite common causes like ulcers and diverticulosis.
Area of Science:
- Gastroenterology
- Internal Medicine
- Clinical Research
Background:
- Gastrointestinal (GI) bleeding is a prevalent medical condition.
- Historically, mortality rates for GI bleeding have remained stagnant for five decades.
Purpose of the Study:
- To prospectively evaluate acute upper GI (UGI) and lower GI (LGI) bleeding.
- To identify causes, rebleeding rates, therapeutic interventions, and mortality associated with GI bleeding.
Main Methods:
- Prospective evaluation of 796 UGI and 165 LGI bleeding patients over 50 months.
- Standardized data collection including clinical variables.
- Endoscopic examination (upper endoscopy, colonoscopy) to determine bleeding etiology.
Main Results:
- Common UGI causes: gastric ulcer (32%), duodenal ulcer (28%). Common LGI causes: colonic diverticulosis (56%).
- Rebleeding rates: 14% for UGI, 20% for LGI. Surgical therapy needed in 7% (UGI) and 10% (LGI).
- Mortality: 9% for UGI (associated with portal hypertension, rebleeding), 4% for LGI.
Conclusions:
- Causes of GI bleeding show little change over decades.
- This study observed low rates of surgical intervention and mortality for both UGI and LGI bleeding.
Background:
Gastrointestinal (GI) bleeding remains a common medical condition, with a mortality rate believed to have remained unchanged over the past five decades.
Methods:
Over a 50-month period, the gastroenterology consultative service at a large inner-city hospital prospectively evaluated acute upper GI (UGI) bleeding or lower GI (LGI) bleeding in consecutive patients. A number of clinical variables were recorded at admission on a standardized data collection form. The cause of bleeding was determined in most patients by endoscopic examination.
Results:
Of the 796 patients assessed for UGI bleeding, 727 (91%) had upper endoscopy. The most common causes of UGI bleeding were gastric ulcer (32%), duodenal ulcer (28%), esophageal varices (9%), and Mallory-Weiss tear (6%). The rebleeding rate was 14% and 20% of patients had endoscopic therapy. Surgical therapy for bleeding was required in 7% of patients. Of the 165 patients assessed for LGI bleeding, 150 (91%) had colonoscopy. Colonic diverticulosis was considered etiologic in 56% of patients, followed by colonic ulcers in 10%, carcinoma in 7%, and vascular ectasias in 5%. The rebleeding rate in these patients was 20%, and surgical therapy for bleeding was required in 10%. The overall mortality for patients with UGI bleeding was 9% and was independently associated with portal hypertension and rebleeding. In contrast, the mortality rate for LGI bleeding was 4%, and there was little power to determine significant factors associated with death.
Conclusions:
The causes of gastrointestinal bleeding remain little changed over the past several decades, though in our large series the need for surgical therapy and the mortality from both upper and lower GI bleeding were low.
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