Trends on gastrointestinal bleeding and mortality: Where are we standing?

Table 1 Causes of acute upper gastrointestinal bleeding

Common	Gastric ulcer
	Duodenal ulcer
	Esophageal varices
	Malory-Weiss tear
Less common	Gastric erosive/gastropathy
	Esophagitis
	Cameron lesions
	Dieulatory lesion
	Telangiectasias
	Portal hypertensive gastropathy
	Gastric antral vascular ectasia (watermelon stomach)
	Gastric varices
	Neoplasms
Rare	Esophageal ulcer
	Erosive duodenitis
	Aortoenteric fistula
	Hemobilia
	Pancreatic disease
	Crohn's disease

Table 2 Causes of acute lower gastrointestinal bleeding

Common	Colonic diverticula
	Angioectasia
Less common	Colonic neoplasms (including post polypectomy bleeding)
	Inflammatory bowel disease
	Colitis
	Ischemic
	Raditation
	Unspecified (infectious or non specific)
	Haemorrhoids
	Small bowel source
	Upper gastrointestinal source
Rare	Dieulatory lesion
	Colonic ulcerations
	Rectal varices

Table 3 Trends of hospitalization for gastrointestinal bleeding in the United States in 1996 and 2006

	Total number of discharges per 100 000 persons (principal diagnosis)			Total number of discharges per 100 000 persons (all diagnosis)
	1998	2006	Percent changes (%)	1998	2006	Percent changes (%)
	189	182	-3.8	390	375	-3.7
By bleeding site
Upper	96	82	-14	170	146	-14
Lower	43	44	+2	75	82	+8
Unspecified	50	56	+11	156	158	+1
By age (yr)
< 20	7.4	7.5	+1.5	23	25	+8.6
20-29	25	23	-7	55	59	+6.1
30-44	65	59	-8.3	139	140	+0.6
45-64	187	181	-3.4	399	396	-0.9
65-84	859	806	-5.6	1731	1596	-7.8
> 85	2207	1871	-15.2	4257	4375	-18.4
By sex (%)
Female	259 808 (51)	276 663 (51)
Male	252 060 (49)	268 589 (49)

Table 4 Death rates for gastrointestinal bleeding inpatients

	1998	2006	Percentage change (%)
Inpatient death number	20 013	16 344	-18
Inpatient death number/100 000	7	5	-26
Inpatient death rate (%)
By bleeding site
Upper	3.5	2.7	-23
Lower	3.5	2.9	-17
Unspecified	5	3.6	-28
By sex
Male	4	3	-25
Female	3.8	3	-21
By age (yr)
< 20	-	-	-
20-29	-	-	-
30-44	1.6	1.1	-31
45-64	2.7	2.2	-19
65-84	4.1	3	-27
> 85	6.4	5.2	-19

Table 5 Underlying conditions of gastrointestinal in 1998 and 2006 n (%)

Underlying condition	1998	2006	Discharge percentage change (principal diagnosis)	1998	2006	Discharge percentage change (all diagnosis)
Upper GI: oesophageal varices, ulcer, perforation and other haemorrhages	23 007 (4)	35 058 (6)	52% and 38% after population adjustment	84 382 (8)	103 381 (9)	23% and 11% after population adjustment
Gastric, duodenal ulcers, gastrojejinal uklcers or perforation	156 29 (31)	131 225 (24)	-16% and -24% after population adjustment	215 912 (20)	179 032 (16)	-17% and -25%after population adjustment
Gastritis or duiodenitis and haemorrhage	54 310 (11)	44 104 (8)	-19% and -27% after population adjustment	118 333 (11)	90 635 (8)	-23% and -31%after population adjustment
Angiodysplasia of stomach and dudodenum with haemorrhage	9237 (2)	14 679 (3)	59% and 43% after population adjustment	15 061 (1)	23 032 (2)	53% and 38% after population adjustment
Haematemesis	16 466 (3)	21 230 (4)	29% and 16% after population adjustment	58 955 (6)	72 655 (6)	23% and 11% after population adjustment
Perforation of the large intestine	9117 (2)	10 066 (2)	10% and -0.3% after population adjustment	26 200 (2)	33 246 (3)	27% and 15% after population adjustment
Haemorrhage of rectum and anus	12 084 (2)	21 456 (4)	78% and 60% after population adjustment	52 974 (5)	85 592 (7)	56% and 41% after population adjustment
Diverticulosis and diverticulitis of the colon and haemorrhage	80 007 (16)	83 927 (15)	5% and -5% after population adjustment	101 000 (10)	104 516 (9)	3% and -7% after population adjustment
Diverticulosis and diverticulitis of the small intestine and haemorrhage	15 369 (3)	16 259 (3)	6% and -5% after population adjustment	26 933 (3)	27 433 (2)	2% and -8% after population adjustment
Unspecified GI bleeding (blood in stool)	31 044 (6)	38 284 (7)	23% and 11% after population adjustment	283 440 (27)	325 035 (29)	15% and 4% after population adjustment
Haemorrhage of GI tract (unspecified)	104 991 (21)	129 164 (24)	23% and 11% after population adjustment	283 440 (27)	325 035 (29)	15% and 4% after population adjustment

GI: Gastrointestinal.

Table 6 Causes of occult gastrointestinal bleeding

Mass lesions	Carcinoma (any site)
	Large > 1.5 cm adenoma (any site)
Inflammatory lesions	Erosive oesophagitis ulcer (any site)
	Cameron lesion
	Erosive gastropathy
	Celiac sprue
	Ulcerative colitis
	Crohn's disease
	Non specific colitis
	Caecal ulcer
Vascular lesions	Angiodysplasia (any site)
	Portal hypertensive gastropathy (colonpathy)
	Gastric antral vascular ectasia
	Hemangioma
	Dieulatory lesion
Infection	Hockworm
	Whipworm
	Stronyloidosis
	Ascariosis
	Tuberculous enterocolitis
	Amoebiasis
	Cytomegalo virus