Outcomes Of Non-variceal Upper Gastrointestinal Bleeding Research Articles

Comparative diagnostic utility of Rockall and Glasgow-Blatchford scores in non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis.

The Rockall score and Glasgow-Blatchford score (GBS) are two scoring systems validated in the evaluation of upper gastrointestinal bleeding (UGIB). However, no meta-analysis exists to summarize the current data and clarify the use of Rockall score and GBS focusing on non-variceal UGIB. We aimed to evaluate and compare the utility of the Rockall score and GBS in predicting clinical outcomes in non-variceal UGIB. We conducted a systematic review and meta-analysis, searching the MEDLINE and EMBASE databases for all peer-reviewed articles using the terms including 'Glasgow-Blatchford', 'Rockall', and 'gastrointestinal bleed' from their inception to 22 March 2023. Outcomes included mortality, rebleeding, need for blood transfusion, and need for surgical intervention. Seven studies with 755 participants with non-variceal bleeding were included in the analysis. Pooled analysis demonstrated no difference in the area under the receiver operating characteristic (AUROC) between GBS and Rockall score to predict mortality [weighted mean difference (WMD) = 0.01, 95% CI: -0.06 to 0.08] or rebleeding (WMD = 0.04, 95% CI: -0.03 to 0.11). GBS had a higher AUROC to predict the outcomes compared to Rockall score for the needs for transfusion (WMD = 0.09, 95% CI: 0.01-0.16) and surgical intervention (WMD = 0.21, 95% CI: 0.14-0.29). The GBS could be superior to the Rockall score in predicting the needs for transfusion and surgical intervention in non-variceal UGIB. However, both scores demonstrate low performance for predicting mortality or rebleeding.

Racial Differences in Non-variceal Upper Gastrointestinal (GI) Bleeding: A Nationwide Study.

Background and aims Knowledge about the impact of race on non-variceal upper GI bleeding (NVUGIB) is limited. This study explored the racial differences in the etiology and outcome of NVUGIB. Methods We conducted a study from 2009 to 2014 using the Nationwide Inpatient Sample (NIS) database. NIS is the largest publicly available all-payer inpatient database in the USA with more than seven million hospital stays each year. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for NVUGIB, esophagogastroduodenoscopy (EGD) and demographics were obtained. The outcomes of interest were in-hospital mortality, hospital length of stay (HLOS), total hospital charges, admission to the intensive care unit (ICU), and patient disposition. Analysis was conducted using Chi-square tests and Tukey multiple comparisons between groups. Results Among 1,082,516 patients with NVUGIB, African American and Native Americans had the highest proportions of hemorrhagic gastritis/duodenitis (8.2% and 4.2%, respectively) and Mallory-Weiss bleeding (10.4% and 5.4%, respectively; p<0.01). African Americans were less likely to get an EGD done within 24 hours of admission compared to Whites and Latinxs (45.9% vs 50.1% and 50.4%, respectively; p<0.001). In-hospital mortality was similar among African Americans, Latinxs, and Whites (5.8% vs 5.6% vs 5.9%, respectively; p=0.175). Asian/Pacific Islanders and African Americans were more likely to be admitted to the ICU (9.6% and 9.0%, respectively; p<0.001). Moreover, African Americans had a longer HLOS compared to Latinxs and Whites (7.5 vs 6.5 and 6.4 days, respectively; p<0.001). Conversely, Asian/Pacific Islanders and Latinx incurred the highest hospital total charges compared to African Americans and Whites ($81,821 and $69,267 vs $61,484 and $53,767, respectively; p<0.001). Conclusion African Americans are less likely to receive EGD within 24 hours of admission and are more likely to be admitted to the ICU with prolonged hospital lengths of stay. Latinxs are more likely to be uninsured and incur the highest hospital costs.

Relationships of hospitalization outcomes and timing to endoscopy in non-variceal upper gastrointestinal bleeding: A nationwide analysis.

The optimal timing of esophagogastroduodenoscopy (EGD) and the impact of clinico-demographic factors on hospitalization outcomes in non-variceal upper gastrointestinal bleeding (NVUGIB) remains an area of active research. To identify independent predictors of outcomes in patients with NVUGIB, with a particular focus on EGD timing, anticoagulation (AC) status, and demographic features. A retrospective analysis of adult patients with NVUGIB from 2009 to 2014 was performed using validated ICD-9 codes from the National Inpatient Sample database. Patients were stratified by EGD timing relative to hospital admission (≤ 24 h, 24-48 h, 48-72 h, and > 72 h) and then by AC status (yes/no). The primary outcome was all-cause inpatient mortality. Secondary outcomes included healthcare usage. Of the 1082516 patients admitted for NVUGIB, 553186 (51.1%) underwent EGD. The mean time to EGD was 52.8 h. Early (< 24 h from admission) EGD was associated with significantly decreased mortality, less frequent intensive care unit admission, shorter length of hospital stays, lower hospital costs, and an increased likelihood of discharge to home (all with P < 0.001). AC status was not associated with mortality among patients who underwent early EGD (aOR 0.88, P = 0.193). Male sex (OR 1.30) and Hispanic (OR 1.10) or Asian (aOR 1.38) race were also independent predictors of adverse hospitalization outcomes in NVUGIB. Based on this large, nationwide study, early EGD in NVUGIB is associated with lower mortality and decreased healthcare usage, irrespective of AC status. These findings may help guide clinical management and would benefit from prospective validation.

Non-variceal upper gastrointestinal bleeding in patients with acute leukemia.

e19041 Background: Patients with acute leukemia are prone to various hemorrhages, most frequently due to thrombocytopenia from disease activity or chemotherapy. However, there is minimal literature evaluating non-variceal upper gastrointestinal bleeding (NVUGIB) in leukemia patients. This study evaluates the outcomes of NVUGIB in hospitalized acute leukemia patients. Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of NVUGIB and a concomitant acute leukemia diagnosis, acute myelogenous leukemia and acute lymphoblastic leukemia. The control group included non-leukemia patients with NVUGIB. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), hospital charges, and effect of early esophagogastroduodenoscopy (EGD) within the first 24 hours of admission. Multivariate logistic regression was used to adjust for comorbidities and demographic variables. Results: A total of 1,208,885 discharges were identified with NVUGIB. Of those, 1019 had acute leukemia. Leukemia patients had higher mortality than the general population (12.5% vs. 3%, respectively; P &lt;0.01). After adjusting for comorbidities and demographic variables, acute leukemia patients had significantly higher mortality (adjusted odds ratio [AOR] 3.75, 95%CI 2.37-5.94 P &lt;0.01). Mean length of stay and hospital charges increased by 6.87 days (95%CI 3.99-9.75, P &lt; 0.01) and 128,437$ (95%CI 68,633$-188,240$, P &lt; 0.01), respectively, in the acute leukemia group. Additionally, acute leukemia patients who had an early EGD had significantly less mortality, length of stay, and hospital charges compared to delayed EGD as shown in the attached table. Conclusions: Acute leukemia patients admitted with NVUGIB have significantly higher in-hospital mortality and health care burden. Early EGD in these patients is associated with lower in-hospital mortality, shorter length of stay, and lower total hospital costs. However, given the retrospective nature of this study, we cannot determine that early EGD is a causal factor for the improved outcomes. Future prospective studies will be required in acute leukemia patients admitted with NVUGIB to further evaluate these findings.[Table: see text]

The Current Portrayal of Non-Variceal Upper Gastrointestinal Bleeding in a Portuguese Tertiary Center

Introduction: Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB. Methods: Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center. Results: A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within <12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS. Discussion/Conclusion: Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system.

Tu1741 Recent Outcomes and Characteristics of Non-Variceal Upper Gastrointestinal Bleeding in a Tertiary Referral Hospital

Despite recent development of diagnostic and therapeutic endoscopy, there is still significant morbidity and mortality in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, there is scant knowledge of recent characteristic and outcomes. The aim of this study was to investigate characteristics and outcomes of NVUGIB in a tertiary referral hospital in Korea.

334 Antithrombotic Drugs and Non-Variceal Bleeding Outcomes and Risk Scoring Systems -Comparison of Blatchford, Rockall, and Charlson Scores

Introduction Antithrombotic drugs (ATDs) commonly cause non-variceal upper gastrointestinal bleeding (NVUGIB). Established risk scoring systems have not been validated in users of these drugs. We aimed to compare Blatchford, Rockall, and Charlson scores in predicting the outcomes of NVUGIB in ATD users and controls. Methods A total of 2071 patients with NVUGIB, 2005–2011, were grouped into ATD users (n = 851) and controls (n = 1220). ATDs included low-dose aspirin, clopidogrel, dipyridamole, warfarin, and low-molecular weight heparin. Outcomes included length of hospital admission, the need for blood transfusion, re-bleeding requiring surgery, and 30-day mortality. Results were expressed as Spearman rank correlation coefficients (Rs) for length of admission and area-under-the-curve (AUC) values for the receiver opating characteristic curves (ROC) for binary outcomes, and were compared using z-tests, after Fisher’s transformation in the case of Rs values. Results (1) The LENGTH OF ADMISSION correlated with all three scores in non-ATD patients (controls), but these correlations were significantly weaker in ATD users. Rs in control vs. ATD: 0.45 vs. 0.20 for Blatchford; 0.48 vs. 0.32 for Rockall; and 0.42 vs. 0.26 for Charlson, all P Conclusion (1) In both ATD users and controls, the Blatchford score was the strongest predictor of the need for blood transfusion, Rockall had the strongest correlation with duration of admission and with re-bleeding requiring surgery, and Charlson was best in predicting 30-day mortality. (2) There was a consistent tendency for all scoring systems to be less effective in predicting outcomes in ATD users than in controls. (3) Modifications of risk scoring systems should be explored to improve their efficiency in users of antithrombotic drugs. Disclosure of Interest A. Taha Consultant for: Almiral UK, Vifor UK, Horizon Pharma USA, C. McCloskey: None Declared, T. Craigen: None Declared, W. Angerson: None Declared.

The “Prometeo” Study

To implement an online, prospective collection of clinical data and outcome of patients with acute nonvariceal upper gastrointestinal bleeding (UGIB) in Italy ("Prometeo" study). Epidemiology, clinical features, and outcomes of nonvariceal UGIB are mainly known by retrospective studies and are probably changing. Data were collected by 13 Gastrointestinal Units in Italy from June 2006 to June 2007 (phase 1) and from December 2008 to December 2009 (phase 2): an interim analysis of data was performed between the 2 phases to optimize the online database. All the patients consecutively admitted for acute nonvariceal UGIB were enrolled. Demographic and clinical data were collected, a diagnostic endoscopy performed, with endoscopic hemostasis if indicated. One thousand four hundred thirteen patients (M=932, mean age±SD=66.5±15.8; F=481, mean age±SD=74.2±14.6) were enrolled. Comorbidities were present in 83%. 52.4% were treated with acetyl salicylic acid or other nonsteroidal anti-inflammatory drugs (NSAIDs): only 13.9% had an effective gastroprotection. Previous episodes of UGIB were present in 13.3%. Transfusion were needed in 43.9%. Shock was present in 9.3%. Endoscopic diagnosis was made in 93.2%: peptic lesions were the main cause of bleeding (duodenal ulcer 36.2%, gastric ulcer 29.6%, gastric/duodenal erosions 10.9%). At endoscopy, Helicobacter pylori was searched in 37.2%, and found positive in 51.3% of tested cases. Early rebleeding was observed in 5.4%: surgery was required in 14.3% of them. Bleeding-related death occurred in 4.0%: at multivariate analysis, the risk of death was correlated with female sex [odds ratio (OR=2.19, P=0.0089)], presence of neoplasia (OR=2.70, P=0.0057) or multiple comorbidities (OR=5.04, P=0.0280), shock at admission (OR=4.55, P=0.0001), and early rebleeding (OR=1.47, P=0.004). Prometeo database has provided an up-to-date picture of acute nonvariceal UGIB in Italy: patients are elderly, predominantly males, and with important comorbidities. Gastroprotection is underutilized during NSAIDs treatment. With respect to previous studies, Prometeo shows a higher incidence of low-dose acetyl salicylic acid use and comorbidities, whereas no significant difference were found in other items (etiology of bleeding, NSAIDs use, need for endoscopic hemostasis, incidence of rebleeding, and overall mortality).

What Role Does Surgery Play in the Modern Day Management of Non-Variceal Upper Gastrointestinal Bleeding?

Introduction Combinations of endoscopic, pharmacological and radiological intervention appears to have reduced the need for surgery in non-variceal upper gastrointestinal bleeding (NVUGIB), for what was once a condition primarily managed by surgeons. The place of surgery in today9s management of NVUGIB remains poorly characterised. Methods We examined the clinical characteristics, sequence of intervention and outcomes of NVUGIB in a nationwide study, by analysing patients coming to surgery in the 2007 national audit of Acute Upper Gastrointestinal Bleeding1. Results The study recruited 6,750 patients. Only 1.9% (127/6750) underwent surgery. The mean age was 69.4 (SD 15) years, 60% (75/127) male, with median of 1 co-morbid illnesses. Indications for surgery were uncontrolled bleeding/high risk stigmata of haemorrhage in 82% (104/127), peritonitis/perforation in 12% (15/127), malignancy in 4% (5/127), and other indications in 9% (12/127). Surgical procedures were oversew or under-run of an ulcer in 65% (83/127), partial gastrectomy in 9% (12/127), excision of an ulcer with vagotomy/pyloroplasty (2%) and other procedure in 20%. Surgery was performed outside of normal working hours in 54% (69/127), lead by a consultant surgeon in 71% (90/127) with a consultant anaesthetist in 64% (81/127). A median of 1 endoscopy was performed prior to surgery and 5% (6/127) had also undergone mesenteric angiography, with apparently successful embolisation in 33% (2/6) of cases. Mortality following surgery was 30% (38/127). Post-operative complications occurred in 65% (82/127). Compared to patients managed non-surgically, patients requiring surgery were older (mean 69.4yrs vs. 64.3 yrs, p Conclusion Modern day management of NVUGIB rarely requires surgical intervention. Given the high mortality and complication rates of patients following surgery, its role and timeliness needs re-evaluation in the hope of improving outcomes following AUGIB.

* What role does surgery play in the modern day management of non-variceal upper gastrointestinal bleeding?

IntroductionCombinations of endoscopic, pharmacological and radiological intervention appears to have reduced the need for surgery in non-variceal upper gastrointestinal bleeding (NVUGIB), for what was once a condition primarily managed by...