Evaluation of Change in Etiology and Epidemiology of Upper GI Bleeding in A Population Study

Abstract

Background: Acute upper GI bleeding (UGIB) is a common medical emergency situation. In the past years, important changes have taken place that might have influenced the incidence, etiology, and outcome for patients with acute UGIB. The aim of this study was to determine current time trends in the incidence, management, and prognosis of patients with UGIB in 14 years period in a region in center of Iran.

Materials and Methods: All of the patients with UGIB who hospitalized in all hospitals from 1991 to 2004 in Semnan city were evaluated in a retrospective study. The patients with permanent residency in this area and age more than 15 years enrolled in the study. The patients were divided in two subgroups based on endoscpic diagnosis; peptic ulcer (PU) and non-peptic ulcer (Non-PU). Again, analysis was performed by dividing the patients to acid-pepsin disorders (APDs) and non-acid pepsin disorders (Non-APDs).

Results: 873 patients [617 male (70.7%), Mean ± SD (46.9±21.2)] enrolled in the study. The incidence rate of UGIB has decreased from 98.4 to 40.1 in 100.000 person in year in this period (p‹0.001). The incidence rates of bleeding due to PU and Non-PU have decreased. However, in the second analysis the rate of APDs has decreased, but the rate of non-APDs has remained unchanged, during the study period. In regard to prognosis, the rates of endoscopic therapy, surgery and mortality were not changed significantly in this period.

Conclusion: The overall incidence of UGIB, and bleeding due to APDs was declined in recent years that may be due to better approach to peptic ulcers and eradication of helicobacter pylori and wide spread use of PPIs and H2 blockers in APDs.