Few Changes in GI Bleeding Causes

Upper GI bleeding causes similar to what they were 20 years ago

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Vomit lined with blood and blood found in feces are signs of a major condition happening inside the body. But what causes that bleeding?

The causes of bleeding between the mouth and stomach have changed slightly over the last 20 years, a new study has found.

While ulcers have decreased as a cause for bleeding, abnormal veins continue to be a major cause.

These research findings show which patients with upper gastrointestinal (GI) bleeding are more at risk of death.

"Dark, bloody stools?  Call a doctor."

The study looked at the sources of upper GI bleeding in more than 1,900 patients at an urban hospital compared to sources at the same center two decades ago.

The researchers, led by John Kim, MD, from the Division of Gastroenterology, Loma Linda University Medical Center in California, also looked at the outcomes related to the sources that cause upper GI bleeding.

The researchers identified patients who were undergoing upper endoscopy, between January 2005 and June 2011 at LA County + USC Medical Center. Endoscopy is a procedure that allows a doctor to look inside the body through a camera inserted on the end of a long, thin tube.

The patients were about 52 years of age on average and three-quarters of them were men. More than half the patients had vomited blood; 42 percent had dark, tar-like feces, and 2 percent (or 47 patients) had blood in their stools or anus.

The researchers tracked patients' gender, age, race and whether they had health insurance.

The researchers also obtained information through patients' endoscopy reports on their overt bleeding symptoms, source of upper GI bleeding and procedure they underwent to diagnose their condition.

The percentage of upper GI bleeding cases caused by ulcers, or open sores inside the esophagus, went down over the last two decades, researchers found. The esophagus is the tube connecting the mouth and stomach.

In 1991, ulcers caused GI bleeding in 43 percent of patients. Today, ulcers have caused 34 percent of GI bleeding cases.

The second most common cause of GI bleeding was varices, which occurred in 33 percent of patients. Varices are abnormally enlarged veins in the lower part of the esophagus.

The researchers found that number of varices cases that caused GI bleeding had not changed since 1991.

Erosive esophagitis came in third with 156 cases that caused GI bleeding, or 8 percent of the patients. The proportion is up from 2 percent in 1991.

"In summary, peptic ulcer disease has decreased modestly over the past 20 years, mainly due to a decline in duodenal ulcers, whereas varices continue to be a common cause of upper GI bleeding among those hospitalized at a large urban medical center serving a lower socioeconomic population," the researchers wrote in their report.

The researchers also found that almost 11 percent of the patients who were hospitalized required repeat endoscopy to treat their GI bleeding.

In addition, patients who vomited blood or had health insurance were 38 and 44 percent more likely to undergo endoscopy again.

In total, 6.7 percent or 129 patients died due to ulcers and varices. Patients with varices were about 53 percent more likely to die, and those with insurance were about four and a half times more likely to die.

Researchers said they are not sure why this is.

"Patients with insurance in our study were a heterogenous group (43 percent had Medicaid, 7 percent Medicare, and 3 percent commercial insurance) and residual unknown and/or unmeasured confounding factors may be responsible for this ļ¬nding," the researchers wrote in their report.

The authors noted they did not have enough data on patients' related illnesses, medication use, vital signs, lab tests and transfusions.

The researchers might also have missed data on repeat EGD cases, but they said they are likely to be less severe or clinically important.

The study was published online May 16 in the Journal of Clinical Gastroenterology. No conflicts of interest were declared and funding information was not available.

Reviewed by: 
Review Date: 
May 27, 2013
Last Updated:
August 8, 2013