Original Articles
The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated☆

https://doi.org/10.1016/S0016-5107(04)00181-6Get rights and content

Abstract

Background

Peptic ulcer disease is considered the cause of upper-GI bleeding in 50% of cases. A recent decline in the proportion of cases of upper-GI bleeding because of a peptic ulcer was noted by us. The objectives of this study were to evaluate the frequency of peptic ulcer in patients with upper-GI bleeding and the proportion of bleeding peptic ulcers with a non-bleeding visible vessel.

Methods

Patients with upper-GI bleeding seen from December 1999 until April 2001 at a tertiary, university-affiliated medical center were studied prospectively. The Clinical Outcome Research Initiative (CORI) database was used to correlate the single institution data with nationwide data. Endoscopic data in the CORI database for patients who had endoscopy for upper-GI bleeding between December 1999 and July 2001 were retrieved and analyzed.

Results

A total of 126 patients were included in the prospective study. The endoscopic findings were: peptic ulcer in 31.8%: 95% confidence interval (CI) [23.7%, 40.6%] of patients; a non-bleeding visible vessel was present in 10%: 95% CI[2.8%, 23.7%] of these peptic ulcers. From the nationwide CORI database, data for 7822 patients with upper-GI bleeding were obtained. The endoscopic findings were: peptic ulcer in 20.6%:95% CI[19.7%, 21.5%] of patients with upper-GI bleeding; a non-bleeding visible vessel was present in 7.3%: 95% CI[6.1%, 8.6%] of the ulcers.

Conclusions

The frequency of peptic ulcer in patients with upper-GI bleeding and the proportion of bleeding ulcers with a non-bleeding visible vessel are less than previously reported.

Section snippets

Patients and methods

The study was carried out on two levels, local (GUMC), and national (CORI users). The institutional review boards at GUMC and for CORI approved the study.

At GUMC, all patients hospitalized with suspected UGIB between December 1999 and April 2001 were asked to participate in the study. For inclusion, patients had to have an upper endoscopy, consent to the study, and meet none of the following exclusion criteria: (1) age less than 18 years, (2) pregnancy or lactation, (3) unable or unwilling to

GUMC data

Patient characteristics are summarized in Table 1. The mean age of the 126 patients was 62.2 years (range 19-95 years). The ratio of men to women was 2.4:1. Comorbid conditions included coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and diabetes. Upper endoscopy was performed within 24 hours of last stated bleeding in 62.7% of patients, and within 72 hours in all patients. After presentation, endoscopy was performed within 12 hours in almost all

Discussion

The frequency of PUD as a cause of UGIB was studied in a single tertiary care center and with the use of a national endoscopic database. The study was carried out on two levels, local and national, to address the common problems of applicability and statistical power. A complete data set was collected in the local-level portion of the study, but it would have taken many years to collect enough data to achieve statistically meaningful results. The results from the local study would likely be

Acknowledgements

The authors wish to thank Marshfield Clinic Research Foundation for its support through the assistance of Alice Stargardt and Graig Eldred in the preparation of this manuscript.

References (24)

  • D.A Peura et al.

    The American College of Gastroenterology Bleeding Registry: preliminary findings

    Am J Gastroenterol

    (1997)
  • T.A Rockall et al.

    Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage

    BMJ

    (1995)

    • Cited by (98)

    • Upper gastrointestinal haemorrhage

      2020, Surgery (United Kingdom)

    • Prognostic factors in patients with active non-variceal upper gastrointestinal bleeding

      2019, Arab Journal of Gastroenterology
      Citation Excerpt :

      The annual incidence is 50–150 per 100,000 of the population and even though there have been significant improvements in endoscopic and supportive therapies, the overall mortality remains around 10%, and may even reach 35% in hospitalised patients with serious comorbidities [3,4]. In a recent large CORI (Clinical Outcome Research Initiative) study of UGIB, peptic ulcer was the probable cause of UGIB in only 20% of cases [5]. The incidence of peptic ulcer disease is expected to continue to decline [6].

    • Approach to Patients with Epigastric Pain

      2016, Emergency Medicine Clinics of North America

    • Peptic ulcer characteristics in oral opium and non-opium user patients with upper gastrointestinal bleeding

      2024, BMC Gastroenterology

    • Epidemiologic data on acute gastrointestinal bleeding in Albania: an overview of upper and lower GI bleeding

      2024, Egyptian Liver Journal

    • Assessment of the Causes and Endoscopic Findings in Patients Presented with Upper Gastrointestinal Bleeding: A Single Center Experience

      2023, Bahrain Medical Bulletin
    View all citing articles on Scopus
    ☆

    Presented, in part, as poster presentation at Digestive Diseases Week, May 20-23, 2001, Atlanta, Georgia

    The data in this manuscript were obtained from the Clinical Outcomes Research Initiative's National Endoscopic Database (CORI-NED), with support from National Institutes of Health (NIDDK) U01-DK57132-01

    View full text
    Copyright © 2004 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.