Comparative outcomes in patients with ulcer- vs non-ulcer-related acute upper gastrointestinal bleeding in the United Kingdom: a nationwide cohort of 4478 patients.

Abstract

BACKGROUND: Outcomes after Nonvariceal upper gastrointestinal bleeding (NVUGIB) have historically focused on ulcer-related causes. Little is known regarding non-ulcer bleeding, the most common cause of NVUGIB. AIMS: To compare outcomes between ulcer- and non-ulcer-related NVUGIB and explore whether these could be explained by differences in baseline characteristics, bleeding severity or processes of care. METHODS: Analysis of 4474 patients with NVUGIB from 212 United Kingdom hospitals as part of a nationwide audit. Logistic regression models were used to adjust for baseline characteristics, bleeding severity and processes of care. RESULTS: 1682 patients had ulcer-related and 2792 patients had non-ulcer-related bleeding. Those with ulcer-related bleeding were older (median age 73 vs 69, P < 0.001), less likely to have been taking a PPI (18% vs 32%, P < 0.001), more likely to have been taking aspirin (40% vs 27%, P < 0.001) and present with shock (43% vs 32%, P < 0.001). Furthermore, those with ulcer-related bleeding were more likely to receive blood transfusion (66% vs 39%, P < 0.001), PPI infusion (27% vs 5%, P < 0.001) and endoscopic therapy (37% vs 8%, P < 0.001). Overall, ulcer-related bleeding had higher odds of in-hospital mortality (OR: 1.54; 95% CI: 1.21-1.96, P < 0.0001), rebleeding (OR: 2.08; 95% CI: 1.73-2.51, P < 0.0001) and need for surgical/radiologic intervention (OR: 2.64; 95% CI: 1.85-3.77, P < 0.0001). The associations disappeared after adjustment for bleeding severity, whereas adjustment for patient characteristics or process of care factors had no impact. CONCLUSION: Patients with ulcer-related NVUGIB bleeding have worse outcomes than those with non-ulcer-related NVUGIB bleeding, which is due to more severe bleeding.