Non-tumor Related Gastrointestinal Bleeding in U.S. National Hospitalized Cancer Patients

Abstract

Introduction: Gastrointestinal bleeding (GI) is a known cause of morbidity and mortality. Cancer patients are at a higher risk of bleeding due to bone marrow suppression after chemotherapy, radiation therapy, or metastatic involvement of the bone marrow. The etiologies of bleeding are comparable to that seen in the general population. We aimed to determine and compare the etiologies of GI bleeding in cancer vs non-cancer hospitalized patients. Methods: We used the national inpatient sample (NIS) for the year 2008 to determine etiologies of GI bleed in cancer patients including those with metastatic disease. We used ICD-9-CM codes to extract data of hospitalized individuals in the U.S. for the year 2008. Logistic regression analysis was used to determine statistical significance between the cancer and non-cancer groups for various characteristics and etiologies of bleeding at 95% confidence interval (CI). Results: There were 119,328 inpatient hospitalizations for overt GI bleeding which were divided into cancer and non-cancer inpatient groups and we compared patient demographics, insurance status, type and size of the hospital between the 2 groups (Table 1). Cancer group consisted of significantly higher number of older males (p=<0.001) and had more number of co-morbidities (p=<0.001), than non-cancer group. Cancer group had significantly higher number of cases of leukopenia and thrombocytopenia than the non-cancer group (p=<0.001) and had higher in-hospital mortality (p=<0.001). The prevalence of etiologies of GI bleed among cancer and non-cancer is described in table. While non-malignant causes of GI bleed were significantly higher among non-cancer patients, the prevalence of diverticulosis, hemorrhoids, and non-radiation colitis differed marginally between the 2 groups.Table 1: Comparison of Etiologies of Gastrointestinal Bleeding Between Cancer and Non-cancer GroupsConclusion: Cancer patients who present with GI bleeding tend to be older males with higher incidence of leukopenia and thrombocytopenia. The prevalence of non-tumor related causes of GI bleeding is appreciably higher among patients with cancers and warrants appropriate work-up to treat reversible etiologies as amongst non-cancer population.