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Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting

Hreinsson, Johann P. ; Kalaitzakis, Evangelos LU ; Gudmundsson, Sveinn and Bjornsson, Einar S. (2013) In Scandinavian Journal of Gastroenterology 48(4). p.439-447
Abstract
Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age-and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB. Results. A total... (More)
Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age-and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB. Results. A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004). Conclusions. LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting. (Less)
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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anti-inflammatory agents, gastrointestinal hemorrhage, hematemesis, low-dose aspirin, melena, non-steroidal
in
Scandinavian Journal of Gastroenterology
volume
48
issue
4
pages
439 - 447
publisher
Taylor & Francis
external identifiers
  • wos:000316699600007
  • scopus:84875456796
  • pmid:23356751
ISSN
1502-7708
DOI
10.3109/00365521.2012.763174
language
English
LU publication?
yes
id
685805a6-dc0d-497a-9eab-d18c7c2806de (old id 3749092)
date added to LUP
2016-04-01 13:03:48
date last changed
2024-02-24 17:47:01
@article{685805a6-dc0d-497a-9eab-d18c7c2806de,
  abstract     = {{Objective. The authors aimed to investigate the incidence and outcomes of acute upper gastrointestinal bleeding (AUGIB) and to examine the role of drugs potentially associated with AUGIB. Methods. The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy (UGE), during the year of 2010 at the National University Hospital of Iceland. Drug intake of NSAIDs, low-dose aspirin (LDA), warfarin, SSRIs and bisphosphonates prior to GIB was prospectively registered and also checked in a Pharmaceutical Database covering all prescriptions in Iceland. An age-and gender-matched control group consisted of patients who underwent UGE during the study period and were without GIB. Results. A total of 1731 patients underwent 2058 UGEs. Overall, 156 patients had AUGIB. The crude incidence for AUGIB was 87/100,000 inhabitants per year. The most common etiologies were duodenal (21%) and gastric ulcers (15%). Use of LDA (40% vs. 30%), NSAIDs (20% vs. 8%), warfarin (15% vs. 7%), combination of NSAIDs + LDA (8% vs. 1%) and SSRIs + LDA (8% vs. 3%) were significantly more common among bleeders than non-bleeders. Three patients (1.9%) had emergency surgery and two patients died of AUGIB. Independent predictors of clinically significant bleeding were gastric ulcer (OR 6.6, p = 0.012) and NSAIDs (OR 6.6, p = 0.004). Conclusions. LDA, NSAIDs and warfarin play an important role in AUGIB etiology and particularly combinations of drugs. Gastric ulcer and NSAIDs were independent predictors of severe bleeding. Mortality and the need for surgery during hospitalization was low in this population-based setting.}},
  author       = {{Hreinsson, Johann P. and Kalaitzakis, Evangelos and Gudmundsson, Sveinn and Bjornsson, Einar S.}},
  issn         = {{1502-7708}},
  keywords     = {{anti-inflammatory agents; gastrointestinal hemorrhage; hematemesis; low-dose aspirin; melena; non-steroidal}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{439--447}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian Journal of Gastroenterology}},
  title        = {{Upper gastrointestinal bleeding: incidence, etiology and outcomes in a population-based setting}},
  url          = {{http://dx.doi.org/10.3109/00365521.2012.763174}},
  doi          = {{10.3109/00365521.2012.763174}},
  volume       = {{48}},
  year         = {{2013}},
}