Endoscopy 2012; 44(11): 998-1008
DOI: 10.1055/s-0032-1310006
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Epidemiological and prognostic factors involved in upper gastrointestinal bleeding: results of a French prospective multicenter study

S. Nahon
1   Service d’hepatogastroenterologie, Centre Hospitalier Montfermeil, Montfermeil, France
,
H. Hagège
2   Service d’hepatogastroenterologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
,
J. P. Latrive
3   Service d’hepatogastroenterologie, Centre Hospitalier de Compiègne, Compiègne, France
,
I. Rosa
2   Service d’hepatogastroenterologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
,
B. Nalet
4   Service d’hepatogastroenterologie, Centre Hospitalier de Montélimar, Montélimar, France
,
B. Bour
5   Service d’hepatogastroenterologie, Centre Hospitalier du Mans, Mans, France
,
R. Faroux
6   Service d’hepatogastroenterologie, Centre Hospitalier de La Roche sur Yon, La Roche sur Yon, France
,
P. Gower
7   Service d’hepatogastroenterologie, Centre Hospitalier de Valenciennes, Valenciennes, France
,
J. P. Arpurt
8   Service d’hepatogastroenterologie, Centre Hospitalier d’Avignon, Avignon, France
,
J. Denis
9   Service d’hepatogastroenterologie, Centre Hospitalier de Corbeil, Corbeil, France
,
J. Henrion
10   Service d’hepatogastroenterologie, Hopital de Jolimont, Jolimont, France
,
A. J. Rémy
11   Service d’hepatogastroenterologie, Centre Hospitalier de Perpignan, Perpignan, France
,
A. Pariente
12   Service d’hepatogastroenterologie, Centre Hospitalier de Pau, Pau, France
,
and the Groupe des Hémorragies Digestives Hautes de l’ANGH › Author Affiliations
Further Information

Publication History

submitted 19 November 2011

accepted after revision 10 May 2012

Publication Date:
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.

Table e3,Table e6, Table e7, Table e12 and Appendix e1 are available online: