Falcão Daniela, Alves da Silva Joana, Pereira Guedes Tiago, Garrido Mónica, Novo Inês, Pedroto Isabel
Gastroenterology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
GE Port J Gastroenterol. 2021 May 10;28(6):392-397. doi: 10.1159/000516139. eCollection 2021 Nov-Dec.
Non-variceal upper gastrointestinal bleeding (NVUGIB) is an important healthcare problem whose epidemiology and outcomes have been changing throughout the years. The main goal of this study was to characterize the current demographics, etiologies, and risk factors of NVUGIB.
Analysis of clinical, endoscopic, and outcome data from patients who were admitted for NVUGIB between January 2016 and January 2019 in an emergency department of a tertiary hospital center.
A total of 522 patients were included, with a median age of 71 years, mainly men, with multiple comorbidities. Most patients were directly admitted, while the others were transferred from other hospitals. Peptic ulcer disease was the most common cause of NVUGIB and it was followed by tumor bleeding. Esophagogastroduodenoscopy was performed within <12 h after hospital admission in 51.9%. In-hospital rebleeding occurred in 6.9% and overall mortality was 4.2%. Transferred patients had superior Glasgow-Blatchford score (GBS), required more blood transfusion, endoscopic and surgical interventions, and presented higher rebleeding rate, with similar mortality. Complete Rockall score (CRS) and GBS were predictors of endoscopic therapy. Surgery need was only related to CRS. Patients who rebled had superior pre-endoscopic Rockall score (RS), CRS, and GBS. Mortality was increased in patients with higher RS and CRS.
DISCUSSION/CONCLUSION: Ageing and increasing comorbidities have not been related to worse outcomes in NVUGIB. These findings seem to be the consequence of the correct use of both diagnostic and therapeutic tools in an organized and widely accessible healthcare system.
非静脉曲张性上消化道出血（NVUGIB）是一个重要的医疗问题，其流行病学和结局多年来一直在变化。本研究的主要目的是描述当前NVUGIB的人口统计学特征、病因和危险因素。
对2016年1月至2019年1月在一家三级医院急诊科因NVUGIB入院的患者的临床、内镜和结局数据进行分析。
共纳入522例患者，中位年龄71岁，以男性为主，合并多种疾病。大多数患者直接入院，其他患者从其他医院转诊。消化性溃疡病是NVUGIB最常见的原因，其次是肿瘤出血。51.9%的患者在入院后<12小时内进行了食管胃十二指肠镜检查。院内再出血发生率为6.9%，总死亡率为4.2%。转诊患者的格拉斯哥-布拉奇福德评分（GBS）更高，需要更多的输血、内镜和手术干预，再出血率更高，死亡率相似。完全Rockall评分（CRS）和GBS是内镜治疗的预测指标。手术需求仅与CRS相关。再出血患者的内镜前Rockall评分（RS）、CRS和GBS更高。RS和CRS较高的患者死亡率增加。
讨论/结论：老龄化和合并症增加与NVUGIB的不良结局无关。这些发现似乎是在一个有组织且广泛可及的医疗系统中正确使用诊断和治疗工具的结果。
