Cazacu Sergiu Marian, Parscoveanu Mircea, Rogoveanu Ion, Goganau Alexandru, Vieru Alexandru, Moraru Emil, Cartu Dan
Gastroenterology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Surgery Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
Int J Gen Med. 2024 Dec 13;17:6171-6184. doi: 10.2147/IJGM.S496966. eCollection 2024.
Most studies have shown a declining incidence of upper gastrointestinal bleeding (UGIB) in recent years. Data regarding mortality were controversial; in non-variceal bleeding, the increasing age of the population, increased use of anti-thrombotic and anticoagulant therapy in patients with cardiovascular diseases, and the use of non-steroidal anti-inflammatory drugs are counterbalanced by the progress in endoscopic therapy with stable mortality.
We performed a retrospective, cross-sectional study that included patients admitted with UGIB in Clinical Emergency Hospital Craiova during 2013-2020.
3571 patients with UGIB were selected; a trend toward increased admission for UGIB from 2013 to 2019 was noted, with a significant decrease in 2020. Non-variceal bleeding remains the most frequent form, with a slight increase in variceal bleeding, of Mallory-Weiss syndrome and angiodysplasia, and a 3-fold decrease for unknown etiology bleeding (with no endoscopy performed) during the 2017-2020 period as compared to 2013-2016. There was a trend toward decreased mortality, with lower mortality in 2017-2020 (12.83%) compared to 2013-2016 (17.41%). The mortality for variceal bleeding and peptic ulcer bleeding has declined, but mortality for non-variceal bleeding has slightly increased during 2013-2020. Mortality has decreased in admissions during regular hours/after hours and weekdays/weekends, but the difference (off-hours and weekend effects) had increased. The percentage of endoscopies performed in the first 24 hours after admission and the rate of therapeutic endoscopy increased during 2017-2020; the median time between admission and endoscopy was 17.0 hours during 2017-2020 and 59.1 hours during 2013-2016. The proportion of patients who needed emergency surgery for uncontrolled bleeding has significantly declined since 2013-2015, with an average value of 1% in the last 5 years of the study.
Increased admissions for UGIB, with lower mortality, especially for peptic ulcer bleeding and variceal bleeding were noted; higher percentages of therapeutic endoscopies and endoscopies performed during the first 24 hours after admission were also recorded.
大多数研究表明，近年来上消化道出血（UGIB）的发病率呈下降趋势。关于死亡率的数据存在争议；在非静脉曲张出血方面，人口老龄化、心血管疾病患者抗血栓和抗凝治疗的使用增加以及非甾体抗炎药的使用，与内镜治疗进展使死亡率稳定相抵消。
我们进行了一项回顾性横断面研究，纳入了2013年至2020年期间在克拉约瓦临床急诊医院因UGIB入院的患者。
选取了3571例UGIB患者；注意到2013年至2019年期间UGIB入院人数有增加趋势，2020年显著下降。非静脉曲张出血仍然是最常见的形式，静脉曲张出血、马洛里-魏斯综合征和血管发育异常略有增加，2017 - 2020年期间病因不明出血（未进行内镜检查）与2013 - 2016年相比下降了3倍。死亡率有下降趋势，2017 - 2020年的死亡率（12.83%）低于2013 - 2016年（17.41%）。2013 - 2020年期间，静脉曲张出血和消化性溃疡出血的死亡率下降，但非静脉曲张出血的死亡率略有上升。正常时间/非工作时间以及工作日/周末入院患者的死亡率均有所下降，但差异（非工作时间和周末效应）有所增加。2017 - 2020年期间，入院后24小时内进行内镜检查的百分比和治疗性内镜检查率有所提高；2017 - 2020年入院与内镜检查之间的中位时间为17.0小时，2013 - 2016年为59.1小时。自2013 - 2015年以来，因出血无法控制而需要急诊手术的患者比例显著下降，在研究的最后5年中平均为1%。
注意到UGIB入院人数增加，死亡率降低，尤其是消化性溃疡出血和静脉曲张出血；还记录到入院后24小时内进行治疗性内镜检查和内镜检查的比例更高。
