{"title":"Acute Upper Gastrointestinal Bleeding: Less Severe Bleeding in More Frail and Older Patients, Comparison Between Two Time Periods Fifteen Years Apart.","authors":"Christos Sotiropoulos, Konstantinos Papantoniou, Efthimios Tsounis, Georgia Diamantopoulou, Christos Konstantakis, Georgios Theocharis, Christos Triantos, Konstantinos Thomopoulos","doi":"10.14740/gr1534","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute upper gastrointestinal bleeding (AUGIB) remains a common medical emergency with considerable morbidity and mortality. The aim of this study was to describe the patient characteristics, diagnoses and clinical outcomes of patients presenting with AUGIB nowadays and compare these with those of patients 15 years ago.</p><p><strong>Methods: </strong>This was a single-center survey of adults (> 16 years) presenting with AUGIB to a tertiary hospital. Data from 401 patients presenting with AUGIB in a tertiary hospital between January 1, 2019 and December 31, 2020 were analyzed and compared with data from 434 patients presenting with AUGIB at the same hospital between January 1, 2004 and December 31, 2005.</p><p><strong>Results: </strong>Nowadays, patients were older, mean age was 69.5 (± 15.4) vs. 66.2 (± 16.0) years, they had more frequently coexisting diseases (83.5% vs. 72.8%), especially cardiovascular diseases (62.3% vs. 52.5%), and more individuals were inpatients at onset of bleeding (8.2% vs. 4.1%). In addition, more patients were under anticoagulants (18.5% vs. 6.2%), but less were under acetylsalicylic acid ± clopidogrel (36.9% vs. 33.9%). Carlson Comorbidity Index was higher nowadays (5.6 ± 6.4 vs. 3.4 ± 2.3). Moreover, a peptic ulcer was less frequently found as the cause of bleeding (38.4% vs. 56.9%), while more often nowadays endoscopy was negative (12.7% vs. 3.5%). In patients with peptic ulcer, active bleeding on endoscopy was less frequent (7.1% vs. 14.2%). Also, bleeding spots requiring hemostasis were less common on endoscopy (39.6% vs. 49.4%) and more patients were without spots of recent bleeding (49.4% vs. 38.9%). Finally, the rate of rebleeding statistically decreased (7.8% vs. 4.2%), while overall mortality remained relatively unchanged (5.0% vs. 6.2%).</p><p><strong>Conclusions: </strong>AUGIB episodes nowadays are less severe with less peptic ulcer bleeding, but the patients are older and with more comorbidities.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/fc/gr-15-127.PMC9239490.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastroenterology Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14740/gr1534","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/6/22 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Acute upper gastrointestinal bleeding (AUGIB) remains a common medical emergency with considerable morbidity and mortality. The aim of this study was to describe the patient characteristics, diagnoses and clinical outcomes of patients presenting with AUGIB nowadays and compare these with those of patients 15 years ago.
Methods: This was a single-center survey of adults (> 16 years) presenting with AUGIB to a tertiary hospital. Data from 401 patients presenting with AUGIB in a tertiary hospital between January 1, 2019 and December 31, 2020 were analyzed and compared with data from 434 patients presenting with AUGIB at the same hospital between January 1, 2004 and December 31, 2005.
Results: Nowadays, patients were older, mean age was 69.5 (± 15.4) vs. 66.2 (± 16.0) years, they had more frequently coexisting diseases (83.5% vs. 72.8%), especially cardiovascular diseases (62.3% vs. 52.5%), and more individuals were inpatients at onset of bleeding (8.2% vs. 4.1%). In addition, more patients were under anticoagulants (18.5% vs. 6.2%), but less were under acetylsalicylic acid ± clopidogrel (36.9% vs. 33.9%). Carlson Comorbidity Index was higher nowadays (5.6 ± 6.4 vs. 3.4 ± 2.3). Moreover, a peptic ulcer was less frequently found as the cause of bleeding (38.4% vs. 56.9%), while more often nowadays endoscopy was negative (12.7% vs. 3.5%). In patients with peptic ulcer, active bleeding on endoscopy was less frequent (7.1% vs. 14.2%). Also, bleeding spots requiring hemostasis were less common on endoscopy (39.6% vs. 49.4%) and more patients were without spots of recent bleeding (49.4% vs. 38.9%). Finally, the rate of rebleeding statistically decreased (7.8% vs. 4.2%), while overall mortality remained relatively unchanged (5.0% vs. 6.2%).
Conclusions: AUGIB episodes nowadays are less severe with less peptic ulcer bleeding, but the patients are older and with more comorbidities.
背景:急性上消化道出血(AUGIB)仍然是一种常见的急症，具有相当高的发病率和死亡率。本研究的目的是描述目前AUGIB患者的特征、诊断和临床结果，并将其与15年前的患者进行比较。方法:这是一项单中心调查，对象为在三级医院就诊的患有AUGIB的成人(> 16岁)。分析了2019年1月1日至2020年12月31日期间某三级医院401例AUGIB患者的数据，并将其与2004年1月1日至2005年12月31日同一医院434例AUGIB患者的数据进行了比较。结果:目前患者年龄偏大，平均年龄为69.5(±15.4)岁比66.2(±16.0)岁，合并症发生率较高(83.5%比72.8%)，以心血管疾病居多(62.3%比52.5%)，起病住院患者较多(8.2%比4.1%)。此外，使用抗凝药物的患者较多(18.5%比6.2%)，但使用乙酰水杨酸±氯吡格雷的患者较少(36.9%比33.9%)。卡尔森合并症指数较高(5.6±6.4 vs. 3.4±2.3)。此外，消化性溃疡较少被发现为出血的原因(38.4%对56.9%)，而现在内窥镜检查阴性的情况更常见(12.7%对3.5%)。在消化性溃疡患者中，内镜下活动性出血较少(7.1% vs. 14.2%)。此外，内窥镜检查中需要止血的出血点较少(39.6%对49.4%)，更多的患者近期没有出血点(49.4%对38.9%)。最后，再出血率在统计学上下降(7.8%对4.2%)，而总死亡率保持相对不变(5.0%对6.2%)。结论:目前AUGIB发作较轻，消化性溃疡出血较少，但患者年龄较大，合并症较多。
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