Changing trends in the epidemiology and clinical outcome of acute upper gastrointestinal bleeding in a defined geographical area in Greece

Aim: Acute upper gastrointestinal bleeding (AUGIB) remains a commen medical emergency and an important cause of morbidity and mortality. The aim of this study was to evaluate changes in clinico-epidemiologic characteristics of patients who presented with AUGIB during the last 10 years. Methods: Data from all patients admitted with AUGIB in a defined geographical area in Greece from January I to Decem!)er 31, 2005 (period B) were compared with retrospectively collected data from all patients admitted with AUGIB in the same area 10 years ago, from January I to December 3 1, 1995 (period A). The estimated incidence of AUGIB and peptic ulcer bleeding (PUB) in both periods was calculated using data from the population of this area according to the National Statistical Service. Results: A reduction in the incidence of AUGIB from 162.9/100,000 population in 1995, to 108.3/100,000 population (rate ratio = 0.49, confidence interval 95% = 0.37-0.63) in 2005 and in the incidence of PUB from 104.8/100,000 population to 72.5/100,000 (rate ratio = 0.49, confidence interval 95% = 0.35-0.68) were, respectively, observed. This reduction was mainly due to the reduction in the incidence of duodenal ulcer bleeding (from 66.7 cases/100,000 to 35.5/100,000 population), whereas gastric ulcer bleeding incidence remained unchanged (33.1/100,000 vs. 34.4/100,000 cases). Mean age of patients increased from 59.4 +/- 17.1 years to 66.1 +/- 16.1, P < 0.0001, and the patients' comorbidity. The percentage of NSAIDs' use remained stable (49.3% vs. 48.2%), whereas the use of oral anticoagulants and antiplatelets drugs increased significantly (from 2.2% to 6.8%, P = 0.001 and from 1.2% to 10.8%, P < 0.0001, respectively). Blood transfusion requirements per patient significantly decreased (from 2.5 +/- 2 to 2 +/- 2.4, P = 0.009). The rate of rebleeding in PUB patients and emergency surgical hemostasis statistically decreased (from 12% to 5.9%, P = 0.02 and from 5.9% to 3.1%, P = 0.009, respectively). No significant difference in the overall mortality was observed (3.9% in 1995 vs. 6.5% in 2005). Conclusions: The incidence of AUGIB during the past 10 years significantly decreased, mainly due to the decline in the incidence of bleeding duodenal ulcers. Nowadays, patients are older with more comorbidities, but mortality remains unchanged.