Subscribe to RSS
Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study
submitted 19 November 2011
accepted after revision 10 May 2012
29 October 2012 (online)
Background and study aims: The mortality rate from upper gastrointestinal bleeding (UGIB) remains high, at 5 % – 10 %. The aim of the current study was to describe the epidemiological characteristics, prognostic factors, and actual practice in a cohort of patients with UGIB admitted to French general hospitals.
Methods: From March 2005 to February 2006, a prospective multicenter study was conducted at 53 French hospitals. A total of 3298 patients admitted for UGIB were enrolled consecutively. Patient data were collected up to the date of discharge from hospital.
Results: Data were available for 2130 men and 1073 women (mean age 63 ± 18 years), one-third of whom were taking drugs that would increase the risk of UGIB. The two main causes of bleeding were peptic ulcers (38 %) and esophagogastric varices (EGV) or portal hypertensive gastropathy (24.5 %). Mean Rockall score was 5.0 ± 2.3. Endoscopy was performed on 96 % of patients (within 24 hours in 79 %), and 66 % of those with ulcers and 62.5 % of the EGV patients underwent hemostatic therapy when indicated. Rebleeding occurred in 9.9 % of the patients, and 8.3 % died. Independent predictors of rebleeding were: need for transfusion (odds ratio [OR] 19.1; 95 % confidence interval [95 %CI] 10.1 – 35.9); hemoglobin < 10 g/dL (OR: 1.7; 95 %CI 1.1 – 3.3); Rockall score (OR: 1.4 for each 1 point score increase; 95 %CI 1.0 – 1.9), systolic blood pressure < 100 mmHg (OR: 1.9; 95 %CI 1.4 – 2.5), and signs of recent bleeding (OR: 2.4; 95 %CI 1.7 – 3.5). Independent predictors of mortality were: Rockall score (OR: 2.8; 95 %CI 2.0 – 4.0), co-morbidities (OR: 3.6 for each additional co-morbidity; 95 %CI 2.0 – 6.3), and systolic blood pressure < 100 mmHg (OR: 2.1; 95 %CI 1.8 – 2.8). Rockall score, blood pressure and co-morbidities were taken as continuous variables meaning that the OR was 1.4 for every point increase, it was the same for blood pressure.
Conclusion: UGIB still occurs mainly as a result of peptic ulcers and portal hypertension in France, and causes significant rates of mortality. There is scope for improvement via better prevention (better use of UGIB-facilitating drugs), endoscopic therapy, and management of co-morbidities.
- 1 Barkun AN, Bardou M, Kuipers EJ. International Consensus Upper Gastrointestinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med 2010; 152: 101-113
- 2 Garcia-Tsao G, Lim J. Members of the Veterans Affairs Hepatitis C resource center program. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National hepatitis C Program. Am J Gastroenterol 2009; 104: 1802-1829
- 3 Czernichow P, Hochain P, Nousbaum JB et al. Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol 2000; 12: 175-181
- 4 Rockall TA, Logan RF, Devlin HB, Northfield TC. Risk assessment after acute upper gastrointestinal haemorrhage. Gut 1996; 38: 316-321
- 5 de Franchis R on behalf of the Baveno V Faculty Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2010; 53: 762-768
- 6 Sung JJ, Tsoi KK, Ma TK et al. Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol 2010; 105: 84-89
- 7 Hearnshaw SA, Logan RF, Lowe D et al. Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011; 60: 1327-1335
- 8 Hearnshaw SA, Logan RF, Lowe D et al. Use of endoscopy for management of acute upper gastrointestinal bleeding in the UK: results of a nationwide audit. Gut 2010; 59: 1022-1029
- 9 Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet 1974; 2: 394-397
- 10 Barkun A, Sabbah S, Enns R et al. The Canadian Registry on Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy (RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol 2004; 99: 1238-1246
- 11 Nahon S, Pariente A, Pauwels A, Boruchowicz A. Group of Investigators of the ANGH (Association Nationale des Gastroentérologues des Hôpitaux Généraux). Influence of weekend versus weekday admissions on the prognosis of upper gastrointestinal bleeding caused by portal hypertension: post hoc analysis of a prospective study. J Clin Gastroenterol 2010; 44: 228-229
- 12 Barkun AN, Bardou M, Martel M et al. Prokinetics in acute upper GI bleeding: a meta-analysis. Gastrointest Endosc 2010; 72: 1138-1145
- 13 Nahon S, Pariente EA, Lahmek P et al. Utilisation et efficacité de l’erythromycine avant une endoscopie pour hémorragie digestive haute: résultats de l’observatoire des hémorragies digestives hautes de l’ANGH. Journées Francophones d’ Hépatogastroentérologie et d’Oncologie Digestive, Paris 2011; (Abstr.) Available from: www.snfge.org/01-bibliotheque/0a-resumes-jfpd/2011/5077.html
- 14 Consensus conference: complications of portal hypertension in adults (Paris, December 4–5 2003). [Article in French] Gastroenterol Clin Biol 2004; 28: 324-34
- 15 Lau JY, Leung WK, Wu JC et al. Omeprazole before endoscopy in patients with gastrointestinal bleeding. N Engl J Med 2007; 356: 1631-1640
- 16 Khuroo MS, Yattoo GN, Javid G et al. A comparison of omeprazole and placebo for bleeding peptic ulcer. N Engl J Med 1997; 336: 1054-1058
- 17 Wang CH, Huei-Ming Ma M, Chou HC et al. High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer. A systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 2010; 170: 751-758
- 18 Calvet X, Vergara M, Brullet E et al. Addition of a second endoscopic treatment following epinephrine injection improves outcome in high-risk bleeding ulcers. Gastroenterology 2004; 126: 441-450
- 19 Camellini L, Merighi A, Pagnini C et al. Comparison of three different risk scoring systems in non-variceal upper gastrointestinal bleeding. Dig Liver Dis 2004; 36: 271-277
- 20 Vreeburg EM, Terwee CB, Snel P et al. Validation of the Rockall risk scoring system in upper gastrointestinal bleeding. Gut 1999; 44: 331-564
- 21 Enns RA, Gagnon YM, Barkun AN. RUGBE Investigators Group et al. Validation of the Rockall scoring system for outcomes from non-variceal upper gastrointestinal bleeding in a Canadian setting. World J Gastroenterol 2006; 12: 7779-7785
- 22 Church NI, Dallal HJ, Masson J et al. Validity of the Rockall scoring system after endoscopic therapy for bleeding peptic ulcer: a prospective cohort study. Gastrointest Endosc 2006; 63: 606-612
- 23 Soncini M, Triossi O, Leo P et al. Management of patients with nonvariceal upper gastrointestinal hemorrhage before and after the adoption of the Rockall score, in the Italian Gastroenterology Units. Eur J Gastroenterol Hepatol 2007; 19: 543-547