Targownik Laura E, Nabalamba Alice
Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba.
Clin Gastroenterol Hepatol. 2006 Dec;4(12):1459-1466. doi: 10.1016/j.cgh.2006.08.018. Epub 2006 Nov 13.
BACKGROUND & AIMS: ANVUGIB is a common reason for hospital admission and has been traditionally associated with a mortality rate of 5%-10%. There have been numerous innovations in the prevention and management of ANVUGIB in recent years, although the effect of these innovations on ANVUGIB incidence and outcomes is unknown.
We used the Statistics Canada's Health Person Oriented Information Database [corrected], which contains data characterizing every inpatient hospital admission in Canada between 1993 and 2003. We identified admissions consistent with nonvariceal upper gastrointestinal bleeding using both a broad and narrow ICD-9/ICD-10-based definition. Data were extracted concerning patient demographics, incidence of surgery for complications of upper gastrointestinal bleeding, and overall mortality.
Between 1993 and 2003, ANVUGIB incidence decreased from 77.1 cases to 53.2 per 100,000/y for the broad definition, and from 52.4 to 34.3 cases per 100,000/y for the narrow definition. ANVUGIB incidence rose slightly in 2000, coincident with the introduction of COX-2 inhibitors. The proportion of ANVUGIB subjects requiring surgical intervention declined over the 10 years from 7.1% to 4.5%, although the rate of decline did not increase after the introduction of intravenous proton pump inhibitors (IV PPIs). The mortality rate remained steady at approximately 3.5%.
The incidence of ANVUGIB and the need for operative intervention has been steadily declining since 1993. ANVUGIB-associated mortality remained constant, although at a rate lower than traditionally reported. The impact of IV PPIs on mortality and operative intervention on a population-wide basis is likely minimal.
急性非静脉曲张性上消化道出血（ANVUGIB）是住院的常见原因，传统上其死亡率为5%-10%。近年来，在ANVUGIB的预防和管理方面有许多创新，尽管这些创新对ANVUGIB发病率和结局的影响尚不清楚。
我们使用了加拿大统计局的以健康人为导向的信息数据库[校正后]，该数据库包含1993年至2003年加拿大每次住院患者的特征数据。我们使用基于ICD-9/ICD-10的广义和狭义定义来识别与非静脉曲张性上消化道出血一致的入院病例。提取了有关患者人口统计学、上消化道出血并发症手术发生率和总体死亡率的数据。
1993年至2003年期间，广义定义的ANVUGIB发病率从每10万人年77.1例降至53.2例，狭义定义从每10万人年52.4例降至34.3例。2000年ANVUGIB发病率略有上升，与COX-2抑制剂的引入同时发生。在10年期间，需要手术干预的ANVUGIB患者比例从7.1%降至4.5%，尽管在引入静脉质子泵抑制剂（IV PPIs）后下降速度并未加快。死亡率保持稳定在约3.5%。
自1993年以来，ANVUGIB的发病率和手术干预需求一直在稳步下降。ANVUGIB相关死亡率保持不变，尽管低于传统报道的水平。IV PPIs对全人群死亡率和手术干预的影响可能很小。
