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DG Morgan, J Belbeck, M Lee

McMaster University, Division of Gastroenterology, Hamilton, Ontario

BACKGROUND: Upper GI bleeding is a common problem. Patients with this condition consume a significant proportion of health care resources. Over the last decade there have been significant changes in practice and in available medications. The impact of these changes on GI bleeding is not well described. This study was undertaken to examine upper GI bleeding in a single urban teaching hospital and to compare current data with that describing the same condition collected a decade earlier.

METHODS: Data previously presented on upper GI bleeding from 1991–1992 was compared with data from the same urban teaching hospital for the fiscal year 2002–2003. Data from 1991–1992 was originally identified using ICD9 codes. Current data was extracted from hospital charts identified using ICD10 codes.

RESULTS: Study data from 1991–1992 and 2002–2003 is summarized below: n (223, 146); Age (60.5 yr, 70.5 yr); Female (58%, 45.9%); NSAID (41%, 60.2%); PPI (12.5%, 15.1%); H2RA (30.5%, 10.3%); Surgery (12%, 5.8%); Mortality (1.8%, 13.7%); Hematemesis at presentation (58%, 46%).

CONCLUSION: Fewer patients were diagnosed with upper GI bleeding in 2002-2003 than a decade ago. The population is older and there is a slightly higher proportion of males in the current sample. NSAID use is higher now than a decade ago (NSAID 34.9%, ASA 25.3%). COXIB use was 8.2% but of these, 50% were concomitantly on ASA. A significant number of patients developed bleeding while in hospital (20.5%). That the population was older, had more NSAID use, had multiple medical problems and did not have more gastric prophylaxis than a decade ago could contribute to the increase in mortality seen between the two study periods. That more surgery was done in the study group a decade ago could also reflect that the current upper GI bleed population is in poorer health and less suitable for surgery. There would appear to be a significant need for education about gastric prophylaxis in patients at high risk for developing upper GI bleeding. While there has been a reduction in the total number of patients with upper GI bleeding between the 2 periods, this patient group still remains a large burden for the health care system.

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