Patient Characteristics, Etiology, and Outcomes of Patients Admitted with Upper Gastrointestinal Bleeding

Introduction: Upper gastrointestinal bleeding (UGIB) is a common cause for hospital admission Since the recent advances in the management of UGB, there has been a decrease in the incidence of UGB. However, there appears to be an increased risk of UGB in particular group of patients, such as those with a history of esophageal varices. Methods: Population: Adult patients who were admitted to Cleveland Clinic hospitals with UGIB between September 1, 2015 and December 1, 2015 who underwent esophagogastroduodenoscopy (EGD) during hospitalization or one month following discharge. Methods: Data are presented as mean ± standard deviation, median or frequency. Subjects were classified into 1 of 5 etiology groups based on their EGD findings: 1) normal EGD, 2) gastric ulcer, 3) duodenal ulcer, 4) esophageal varices (EV) and 5) erosive disease. A univariable analysis was performed to assess differences between these etiology groups. In addition, univariable logistic regression analysis was performed to assess factors associated with 3-month mortality in UGIB. Results: A total of 224 subjects with UGIB were included in the study. Average age was 63 ± 17 years and 57% were male. Etiologies of UGIB was dIstrIbuted as demonstrated in figure 1. There was no significant association between the use of NSAIDs or PPIs and the etiologies of UGIB. Subjects with gastric ulcer were more likely to have identifiable bleeding on EGD than those with ED but there was no significant difference with either duodenal ulcer or EV. Overall 3-month mortality was 7.1%. Age was significantly associated with death (for every 5 year increase in age the odds of dying within 3 months of the EGD increased by 21%). Subjects with a history of hepatitis (OR 4.1, 1.02-16.7) and cirrhosis (OR 3.5, 1.03-12.0) were also associated with increased risk of death. Subjects who were hemodynamically stable had 69% less likelihood of dying than those who were not stable. Compared to subjects who did not have a RBC transfusion, those who did had 3.4 times higher odds of dying (OR 3.4, 1.2-9.6).Figure 1Conclusion: Despite the emergence of effective therapies for lowering the risk of ED and PUD, the later remain the most common etiologies of UGIB in our patients. There is no difference in the use of NSAIDS or PPI among patients with GU, DU compared to those with normal EGD finding. Age, hepatitis and cirrhosis are significantly associated with increased risk of death. Further research is needed to confirm these initial findings.Table 1: Patient CharacteristicsTable 2: Factors Associated with Mortality in UGIB: Univariable Logistic Regression Analysis