Dieulafoy’s lesion of the upper GI tract: a comprehensive nationwide database analysis

Abstract

We sought to determine the incidence, risk factors, and treatment outcomes of Dieulafoy's lesion of the upper GI tract (UDL) hemorrhage among adult patients in the United States. UDL and non-Dieulafoy upper GI bleeding (UGIB) were identified from the Nationwide Inpatient Sample and Nationwide Readmission Database using International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System codes. Multivariate logistic (binary) and linear (continuous) regressions were used to model dependent variables. The incidence of UDL hemorrhage was 1.6 of 100,000 persons. Patients with UDL and UGIB who required endoscopic therapeutic intervention had similar in-hospital (adjusted odds ratio [aOR], .77; 95% confidence interval [CI], .42-1.43; P= .41) mortality rates. UDL was associated with more severe systemic illness, including higher rates of mechanical ventilation (aOR, 1.52; 95% CI, 1.07-2.15; P< .05), hypovolemic shock (aOR, 1.50; 95% CI, 1.08-2.08; P< .05), acute kidney injury (aOR, 1.25; 95% CI, 1.02-1.54; P< .05), and multiple endoscopies (aOR, 1.57; 95% CI, 1.28-1.93; P< .05) compared with other UGIB patients who required endoscopic therapeutic intervention. UDL was also associated with higher 30-day all-cause (aOR, 1.23; 95% CI, 1.12-1.35; P< .05) and recurrent bleeding-related (aOR, 1.73; 95% CI, 1.45-2.06; P< .05) readmissions. The rate of successful endoscopic treatment was 96.81%. UDL hemorrhage is an uncommon but highly morbid condition. Current UDL treatment modalities are effective in reducing mortality. Further investigations are warranted to lower recurrent bleeding rates.