Acute nonvariceal upper gastrointestinal bleeding is a common reason for hospital admission.
It has been traditionally associated with a mortality rate of 5% to 10%.
There have been numerous innovations in the prevention and management of acute nonvariceal upper gastrointestinal bleeding in recent years.
However, the effect of these innovations on acute nonvariceal upper gastrointestinal bleeding incidence and outcomes is unknown.
Drs Laura Targownik and Alice Nabalamba from Canada evaluated the Canadian Institute of Health Information database.
This database contains data characterizing every inpatient hospital admission in Canada between 1993 and 2003.
|Surgical interventions declined over the 10 years from 7% to 5%|
|Clinical Gastroenterology & Hepatology|
The researchers identified admissions consistent with nonvariceal upper gastrointestinal bleeding.
The team used both a broad and narrow International Classification of Diseases-9 and 10-based definition to identify these bleeds.
Data were extracted concerning patient demographics, incidence of surgery for complications of upper gastrointestinal bleeding, and overall mortality.
Between 1993 and 2003, nonvariceal upper gastrointestinal bleeding incidence decreased from 77 cases to 53 per 100,000 per year for the broad definition.
The researchers found that the incidence decreased from 52 to 34 cases per 100,000 per year for the narrow definition.
The team observed that the acute nonvariceal upper gastrointestinal bleeding incidence rose slightly in 2000.
The team noted that this was coincident with the introduction of COX-2 inhibitors.
The proportion of acute nonvariceal upper gastrointestinal bleeding subjects requiring surgical intervention declined over the 10 years from 7% to 5%.
However, the researchers noted that although the rate of decline did not increase after the introduction of intravenous proton pump inhibitors.
The team found that the mortality rate remained steady at approximately 4%.
Dr Targownik and colleague concluded, “The incidence of acute nonvariceal upper gastrointestinal bleeding and the need for operative intervention has been steadily declining since 1993.”
“Acute nonvariceal upper gastrointestinal bleeding-associated mortality remained constant, although at a rate lower than traditionally reported.”
“The impact of intravenous proton pump inhibitors on mortality and operative intervention on a population-wide basis is likely minimal.”