MedWire News: Findings from a 2007 UK audit show that rates of acute upper gastrointestinal bleeding (AUGIB) have fallen by 4% since 1993.
Nonetheless, AUGIB still carries a high risk for mortality, especially when the bleeding is variceal or due to a gastrointestinal (GI) tumor, the authors report in the journal Gut.
The team, led by Richard Logan (University of Nottingham), observed the outcomes of 6750 patients, with a mean age of 68 years, who presented to UK hospitals with AUGIB from May through end of June 2007.
Overall, 36.0% of the AUGIB cases were identified as occurring secondary to peptic ulcer disease and 11.0% due to bleeding varices - a rate much higher than the 4.4% variceal bleeding rate observed in 1993.
The authors report that 9% of all the patients had liver cirrhosis, 26% reported consuming excess quantities of alcohol, 11% used non-steroidal anti-inflammatory drugs, and 28% took aspirin regularly.
Over the 2-month study period, 10% of the patients died - a rate that was noticeably lower than the 14% mortality rate observed in the 1993 audit.
In the current audit, mortality rates were highest among patients with variceal bleeding or malignancy, at 15% and 17%, respectively.
Furthermore, mortality was noticeably higher among inpatients and new admissions than in any other patient group, at respective rates of 26% and 7%.
This, say Logan and team, suggests that hospital admission increases the risk for death following AUGIB, and admission should therefore be avoided when possible, especially for uncomplicated AUGIB cases.
Given the observed decline in AUGIB-related mortality since 1993, the authors conclude: "It is likely therefore that the outcome of patients developing AUGIB has improved in the 14 years between the two audits.
"This has occurred despite an increase in variceal bleeding and suggests that improvements in management have translated into lower mortality."
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