The causes of acute upper GI bleedings of non-variceal origin yesterday and today

Background: In our paper published in 1983 we analysed the frequency and causes of acute upper gastrointestinal bleedings in our unit during a three year period. We performed the same analysis 22 years later again.

Aim: The goal of our work was to compare bleeding sources and the incidence of drug induced non-variceal bleedings of the two periods. The ulcer bleeding provoking role of NSAID-s and ASA as well as the H. pylori status were carefully evaluated.

Patients and methods: In 1983 we collected the data of 232 patients with acute upper non-variceal GI bleeding. Previous drug consumptions and emergency endoscopy results were analysed by the patient records retrospectively. In 2003 the same data evaluation was performed of those 153 patients who were admitted to our subintensive ward because of acute non-variceal bleeding. H. pylori was tested only in 2003.

Results: In a 20 year period the ratio of acute bleedings related to ulcers (GU+DU) decreased from 69% to 50% while the frequency of bleeding sources like reflux oesophagitis, Mallory-Weiss lesion, erosive and congestive gastropathy increased from 31% to 50%. A twofold increase in frequency of drug induced (NSAID or ASA) acute bleedings (17% vs. 35%) was detected, while the ratio of alcohol related bleedings was threefold higher in 2003 than in the '80-s. H. pylori positivity among ulcer bleeders in 2003 was 45% (NSAID/ASA-users 32% vs. non-users 57%).

	Source of bleeding				Cause of bleeding
	GU	DU	Eros. Gastr	Other	NSAID	ASA	Alc.
1979–81(n=232)	37%	32%	12%	19%	6%	11%	15%
2003(n=143)	26%	24%	8%	42%	15%	20%	49%

Conclusion: 1.) The proportion of gastroduodenal ulcers as acute bleeding sources remarkable decreased in our region within two decades. 2.) A progressive increase of NSAID/ASA and alcohol related acute non-variceal upper GI bleeding incidence appeared during the same period.