Upper gastrointestinal hemorrhage: Have new therapeutics made a difference?

Chad T Whelan; Peter Kaboli; Qi Zhang; Juned Siddique; Siqin Ye; David O Meltzer

doi:10.1002/jhm.443

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Upper gastrointestinal hemorrhage: Have new therapeutics made a difference?

Journal article

Peer reviewed

Upper gastrointestinal hemorrhage: Have new therapeutics made a difference?

Chad T Whelan, Peter Kaboli, Qi Zhang, Juned Siddique, Siqin Ye and David O Meltzer

Journal of hospital medicine, Vol.4(7), pp.E6-E10

09/2009

DOI: 10.1002/jhm.443

PMID: 19753582

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https://www.ncbi.nlm.nih.gov/pmc/articles/3740765View

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Abstract

Background: To explore the distribution of etiologies and risk factors of upper gastrointestinal hemorrhage (UGH) in the context of new pharmacologic therapies that may alter the risk of UGH. Methods: Retrospective study performed on eligible UGH inpatients at 2 academic medical centers, between July 1, 2001 and June 30, 2003. Administrative data and chart review were used to identify demographics, UGH risk factors, and UGH etiologies. Bivariate and multivariate analyses were performed to describe distributions and associations of risk factors and etiologies. Results: UGH was identified in 227 subjects, with ED (n = 99; 44%), peptic ulcer disease (PUD) (n = 75; 33%), and variceal bleeds (n = 39; 17%) accounting for the majority of bleeds. Known risk factors for UGH occurred in 70% (n = 156) of subjects (prior UGH 43% [n = 90], nonsteroidal anti-inflammatory drug (NSAID) use 23% [n = 52], aspirin [ASA] use 25% [n = 57], NSAID + ASA use 6.6% [n = 15]), while 19% (n = 42) were using a proton-pump inhibitor (PPI) and 5% (n = 11) a cyclooxygenase-2 (COX-2) inhibitor. Subjects at site 1 were more likely to have ED (odds ratio [OR], 7.1; P < 0.001) and less likely to have variceal bleeding (OR, 0.12; P = 0.009) in multivariate analyses. Preventive therapy did not differ between sites. Conclusions: Unlike older studies, PUD was not the most common etiology, suggesting that advances in Helicobacter pylori (H. pylori) eradication may affect the epidemiology of UGH. Despite advances in therapeutics of acid-related disease, ED accounted for the majority of UGH. Most subjects had risk factors for UGH and most were not receiving protective therapy. Large between site-differences in the distribution of etiologies existed.

Epidemiology

gastrointestinal hemorrhage

Details

Title: Subtitle: Upper gastrointestinal hemorrhage: Have new therapeutics made a difference?
Creators: Chad T Whelan - Department of Internal Medicine, University of Chicago, Chicago, Illinois
Peter Kaboli - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Veterans Administration (VA) Medical Center, Iowa City, Iowa
Qi Zhang - School of Community and Environmental Health, Old Dominion University, Norfolk, Virginia
Juned Siddique - Department of Preventive Medicine, Northwestern University, Evanston, Illinois
Siqin Ye - Brigham and Women's Medical Center, Boston, Massachusetts
David O Meltzer - Department of Internal Medicine, University of Chicago, Chicago, Illinois
Resource Type: Journal article
Publication Details: Journal of hospital medicine, Vol.4(7), pp.E6-E10
DOI: 10.1002/jhm.443
PMID: 19753582
NLM abbreviation: J Hosp Med
ISSN: 1553-5592
eISSN: 1553-5606
Publisher: Wiley Subscription Services, Inc., A Wiley Company
Number of pages: 5
Language: English
Date published: 09/2009
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9984094482002771

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