Upper-gastrointestinal bleeding secondary to peptic ulcer disease:Incidence and outcomes

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 46; pp. 17568 - 17577
• Main Authors: Quan, Samuel, Frolkis, Alexandra, Milne, Kaylee, Molodecky, Natalie, Yang, Hong, Dixon, Elijah, Ball, Chad G, Myers, Robert P, Ghosh, Subrata, Hilsden, Robert, van Zanten, Sander Veldhuyzen, Kaplan, Gilaad G
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.12.2014
• Subjects: Adult; Aged; Alberta - epidemiology; Databases, Factual; Digestive; Duodenal Ulcer - diagnosis; Duodenal Ulcer - epidemiology; Duodenal Ulcer - mortality; Duodenal Ulcer - surgery; Epidemiology; Female; hemorrhage; Hemostatic Techniques; Hospital Mortality; Humans; Incidence; International Classification of Diseases; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Readmission; Peptic; Peptic Ulcer Hemorrhage - diagnosis; Peptic Ulcer Hemorrhage - epidemiology; Peptic Ulcer Hemorrhage - mortality; Peptic Ulcer Hemorrhage - surgery; Prospective Studies; Prospective Study; Recurrence; Risk Factors; Rural Health; Stomach Ulcer - diagnosis; Stomach Ulcer - epidemiology; Stomach Ulcer - mortality; Stomach Ulcer - surgery; sys; Time Factors; Treatment Outcome; ulcer; Urban Health; Alberta; Peptic ulcer hemorrhage; Mortality; Endoscopy; Epidemiology; Digestive system surgical procedures; Incidence; Validation studies
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i46.17568

AIM:To evaluate the incidence,surgery,mortality,and readmission of upper gastrointestinal bleeding(UGIB)secondary to peptic ulcer disease(PUD).METHODS:Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta,Canada from 2004 to 2010(n=7079)using the International Classification of Diseases Codes(ICD-10).A subset of the data was validated using endoscopy reports.Positive predictive value and sensitivity with 95%confidence intervals(CI)were calculated.Incidence of UGIB secondary to PUD was calculated.Logistic regression was used to evaluate surgery,in-hospital mortality,and 30-d readmission to hospital with recurrent UGIB secondary to PUD.Co-variants accounted for in our logistic regression model included:age,sex,area of residence(i.e.,urban vs rural),number of Charlson comorbidities,presence of perforated PUD,undergoing upper endoscopy,year of admission,and interventional radiological attempt at controlling bleeding.A subgroup analysis(n=6356)compared outcomes of patients with gastric ulcers to those with duodenal ulcers.Adjusted estimates are presented as odds ratios(OR)with95%CI.RESULTS:The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were85.2%(95%CI:80.2%-90.2%)and 77.1%(95%CI:69.1%-85.2%),respectively.The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per100000.Overall risk of surgery,in-hospital mortality,and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%,8.5%,and 4.7%,respectively.Interventional radiology to control bleeding was performed in 0.6%of patients and 76%of these patients avoided surgical intervention.Thirty-day readmission significantly increased from 3.1%in 2004 to 5.2%in 2010(OR=1.07;95%CI:1.01-1.14).Rural residents(OR rural vs urban:2.35;95%CI:1.83-3.01)and older individuals(OR≥65 vs<65:1.57;95%CI:1.21-2.04)were at higher odds of being readmitted to hospital.Patients with duodenal ulcers had higher odds of dying(OR=1.27;95%CI:1.05-1.53),requiring surgery(OR=1.73;95%CI:1.34-2.23),and being readmitted to hospital(OR=1.54;95%CI:1.19-1.99)when compared to gastric ulcers.CONCLUSION:UGIB secondary to PUD,particularly duodenal ulcers,was associated with significant morbidity and mortality.Early readmissions increased over time and occurred more commonly in rural areas.