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Medical advances help curb GI bleeding mortality rate

Monday October 22, 2012
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The number of patients dying from upper gastrointestinal bleeding has decreased over the past two decades, a result attributable to advances in medical and endoscopic therapies, according to a study

Researchers from Harvard Medical School and Brigham and Women’s Hospital analyzed data from the Nationwide Inpatient Sample to determine the incidence, mortality and resource utilization for upper GI hemorrhage in a nationally representative database.

They reported that despite similar patient age and medical conditions, the inpatient mortality rate for total variceal and non-variceal UGIH "steadily decreased" from 4.69% in 1989 to 2.13% in 2009.

In addition, the proportion of patients who underwent in-hospital endoscopic therapy has increased from 2% to 27%, while the length of hospital stay progressively decreased from 4.5 days to 2.8 days over the time period.

"This means we are decreasing mortality from upper GI bleeding, and we are doing so more efficiently than before," Marwan Abougergi, MD, the study’s lead investigator, said in a news release.

"We have also shown that the rate of decline from mortality from upper GI bleeding is faster than the overall decline in mortality for all patients admitted to hospitals. This suggests that improved treatments specific to gastroenterology are responsible for this change. Further studies are needed to clarify this relationship."

John R. Saltzman, MD, FACG, the study’s senior investigator, noted that over the past five decades, every paper on GI bleeding has reported an unchanged mortality rate of between 3% and 14% from upper GI bleeding despite new endoscopic and medical therapies that have advanced patient care.

"But many of those studies were small and not nationally representative," Saltzman said. "A database of this scale was needed to accurately delineate the trends in upper GI bleeding outcomes. We finally are seeing patient benefits from the advances in medical and endoscopic therapies introduced over the past 20 years."

The study also showed that the overall hospital-based economic burden of upper gastrointestinal hemorrhage more than doubled from $3.3 billion in 1989 to more than $7.6 billion in 2009. "This is a very important finding in the current cost-sensitive healthcare environment," Saltzman said.

The study, "The Inpatient Mortality Rate for Upper Gastrointestinal Hemorrhage (UGIH) is Decreasing in the United States: A Nationwide Analysis Over Two Decades," was presented Oct. 22 in Las Vegas at the American College of Gastroenterology’s 77th annual scientific meeting.


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