Gastrointestinal hemorrhage – some epidemiological characteristics of patients in the period 1994–2003
Keywords:
gastrointestinal hemorrhage, epidemiology, peptic ulcer, complications, mortalityAbstract
Background: Gastrointestinal hemorrhage is a frequent medical problem and a significant cause of morbidity and mortality. The aim of this prospective, cohort study, which was carried out at our institution, was to establish the causes of hemorrhage from the digestive tract and mortality during a 10-year period.
Patients and methods: The study includes patients with emergency endoscopy of the upper gastrointestinal tract and other diagnostic procedures of the digestive tract due to gastrointestinal hemorrhage between January 1, 1994 and December 31, 2003.
Results: 6416 patients were investigated: 2452 women (38.2 %) and 3964 men (61.8 %). The average age of our patients was 59.3 years (a 1–106 year span, SD ± 17.2). In 2142 patients (33.4 %), endoscopic investigation of the upper digestive tube revealed signs of acute or traces of previous hemorrhage. Different methods of endoscopic hemostasis were carried out in 1486 cases (23.2 %). Sequelae of ulcer disease were the cause of hemorrhage in 36.4 % of investigated patients. Frequent causes of hemorrhage were also inflammatory, hemorrhagically-erosive changes of the gastric and duodenal mucosa (16.6 %), esophageal reflux disease (11.2 %), ruptured esophageal varices (10.7 %). Less frequent causes of hemorrhage from the upper digestive tract were different tumors (3.8 %), Mallory-Weiss tear (2.9 %), polyps (1.4 %) and Dieulafoy lesion (1.3 %). In 13.7 % of patients the cause of hemorrhage was in the large bowel and in 0.4 % in the small intestine. More than half of our patients (53.4 %) were aged over 60, 11.4 % older than 80 years. The total mortality of our patients was 9.9 %, the majority of them (8.5 %), were older than 60 years, with concommitant diseases and complications during treatment.
Conclusions: In the observed period, sequelae of ulcer disease were the most significant cause of gastrointestinal hemorrhage. Hemorrhages are frequent in elderly patients who usually have significant medical conditions which increase mortality.
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