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News

Causes and outcomes of upper gastrointestinal bleeding

The latest issue of the Scandanavian Journal of Gastroenterology investigates the incidence, etiology and outcomes in gastrointestinal bleeding.

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Professor Einar Björnsson and colleagues from Iceland investigated the incidence and outcomes of acute upper gastrointestinal bleeding, and examined the role of drugs potentially associated with acute upper gastrointestinal bleeding.

The study was prospective, population-based and consisted of all patients who underwent upper gastrointestinal endoscopy, during the year of 2010 at the National University Hospital of Iceland.

Drug intake of NSAIDs, low-dose aspirin, warfarin, SSRIs and bisphosphonates prior to gastrointestinal bleeding 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 acute upper gastrointestinal bleeding during the study period and were without gastrointestinal bleeding.

Crude incidence for acute upper GI bleeding was 87 per 100,000 inhabitants per year
Scandanavian Journal of Gastroenterology

The team reported that a total of 1731 patients underwent 2058 upper gastrointestinal endoscopy.

Overall, 156 patients had acute upper gastrointestinal bleeding.

The research team noted that crude incidence for acute upper gastrointestinal bleeding was 87 per 100,000 inhabitants per year.

The most common etiologies were duodenal, and gastric ulcers.

Use of low-dose aspirin, NSAIDs, warfarin, combination of NSAIDs + low-dose aspirin, and SSRIs + low-dose aspirin were significantly more common among bleeders than non-bleeders.

The research team noted that 3 patients had emergency surgery, and 2 patients died of acute upper gastrointestinal bleeding.

Independent predictors of clinically significant bleeding were gastric ulcer, and NSAIDs.

Professor Björnsson's team concludes, "LDA, NSAIDs and warfarin play an important role in acute upper gastrointestinal bleeding 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."

Scand J Gastroenterol 2013: 48(4): 439-447
10 April 2013

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