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DG Morgan, J Belbeck, M Lee

McMaster University, Division of Gastroenterology, Hamilton, Ontario

BACKGROUND: Leerdam et al 2003 examined trends in acute GI bleeding (UGIB) in Amsterdam between 1993/1994 and 2000. Incidence, management and prognosis of patients with UGIB were examined for both of these periods. We have examined similar patients in Hamilton at nearly the same times. The aim of this review was to compare UGIB in Amsterdam and Hamilton. Are there similarities in presentation, management and outcomes?

METHODS: Data previously presented on upper GI bleeding in Canada from 1993/1994 was compared with data from a Hamilton 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 for GI bleeding. Standardized data were recorded using Microsoft Excel.

RESULTS: In Amsterdam 1993/1994 n=951; 71% presented with bleeding and 25% bled in hospital; 40% were female; most patients were 60-79 yr. old; 40% had PUD; 46% used NSAID or ASA; 29% had a history of PUD. In Amsterdam 2000 n=769; 67% presented with bleeding and 30% bled in hospital; 44% were female; most patients were 60-79 yr. old; 46% had PUD; 51% used NSAID or ASA; 16% had a history of PUD. In Canada 1993/94 n=1078; all reported presented with bleeding; 40% were female; mean age was 65yr; 44% had active PUD; 52% used NSAID or ASA. In Hamilton 2002/03 n=146; 79% presented with bleeding and 21% bled in hospital; 46% were female; mean age was 70 yr.; 44% had PUD; 60% used NSAID or ASA; 28% had a history of PUD.

CONCLUSION: Remarkably similar patterns of UGIB exist in the Netherlands and Canada in 1993/94 and in 2000/02. The amount of UGIB appears to have decreased in both regions over this time period. Substantial numbers of patients develop bleeding while in hospital. Many elderly patients have significant risks for bleeding such as increased age, previous PUD and NSAID use. Prevention of UGIB needs to be improved. Patients with high risk for developing UGIB must be identified and gastric prophylaxis in NSAID users should be considered.

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