Journal Article

P31 Trends in acute upper GI bleeding: insights from 2022 UK audit with 5000 patients

Stanley, Adrian J, Travis, Simon, Jairath, Vipul, Hearnshaw, Sarah, Nigam, Gaurav, Dhiman, Paula, Murphy, Mike F, Estcourt, Lise, Ratcliffe, Elizabeth, Oakland, Kate, Uberoi, Raman, Kumar, Bhaskar, Douds, Andy, Leithead, Joanna A, Grant-Casey, John, Davies, Paul

2024

Overview

Introduction With the evolving landscape of acute upper GI bleeding (AUGIB) management, a comprehensive understanding of changing clinical outcomes becomes imperative. This report presents findings from the 2022 UK-wide AUGIB audit, comparing them to the 2007 study.MethodsProspective multi-centre observational study of adults (≥16 years) presenting UK hospitals with AUGIB between 3 May and 2 July 2022.ResultsData on 5101 patients (median age 69yr) from 152 participating hospitals are reported. New admissions with AUGIB (n=3905) were younger than inpatients developing AUGIB (median age 67.5 vs 74 yrs, respectively) with fewer comorbidities (63% vs 80%, respectively). At presentation, 16% (802) had chronic liver disease (CLD), 30% (1528) a history of regular alcohol use, 7% (371) were taking non-steroidal anti-inflammatory drugs and 46% (2339) antiplatelets and/or anticoagulants. 83% (4228) patients had an inpatient endoscopy; 30% had peptic ulcer disease (PUD), 9% had varices, and 27% received endoscopic therapy. Reasons for no endoscopy (n=873) were: 56% not clinically indicated/27% outpatient procedure/18% not for active treatment/7% self-discharged/1% transferred to other hospital/6% death. 10% (416/4228) had evidence of further in-patient bleeding after index endoscopy. 9% (440) underwent >1 endoscopy during inpatient stay; 0.8%(42) underwent surgery, 2.6%(134) had interventional radiology (IR) and 49%(2511) were transfused ≥1 packed red blood cells; 4%(212) platelets; and 5%(282) fresh frozen plasma for AUGIB. Median length of stay was 5 days (IQR 3–9). In-hospital mortality was 9%(461); 5.7% in new admissions and 18.4% in inpatients. Comparisons with the 2007 audit revealed significant differences in patient profiles in 2022, including an increase in comorbid patients (67% vs 50%), higher prevalence of anticoagulant use (31% vs 13%), and a greater proportion with underlying CLD (16% vs 9%). A higher percentage of patients underwent inpatient endoscopy (83% vs 74%) in 2022, with reductions in PUD (30% vs 36%) and varices (9% vs 11%). There was a significant increase in those receiving endotherapies (27% vs 24%) and undergoing IR procedures (2.6% vs 1.2%), along with a lower likelihood of further in-patient bleeding after an index endoscopy (10% vs 13%), surgery (0.8% vs 1.9%), and in-hospital mortality (9% vs 10%). All differences were statistically significant (p<0.05).ConclusionsDespite a more co-morbid population, there was reduced recurrent bleeding, need for surgery and in-hospital mortality for AUGIB since 2007. These are possibly linked to improved management and better endoscopic therapy.ReferenceHearnshaw, et al. Gut 2011.

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Anticoagulants / Bleeding / Comorbidity / Endoscopy / Erythrocytes / Hospitals / Liver diseases / Mortality / Nonsteroidal anti-inflammatory drugs / Patients / Peptic ulcers / Poster Presentations / Statistical analysis / Surgery