Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study

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Abstract
Objectives: To determine the incidence and case fatality of acute upper gastrointestinal haemorrhage in the west of Scotland and to identify associated factors. Design: Case ascertainment study. Setting: All hospitals treating adults with acute upper gastrointestinal haemorrhage in the west of Scotland. Subjects: 1882 patients aged 15 years and over treated in hospitals for acute upper gastrointestinal haemorrhage during a six month period. Main outcome measures: Incidence of acute upper gastrointestinal haemorrhage per 100 000 population per year, and case fatality. Results: The annual incidence was 172 per 100 000 people aged 15 and over. The annual population mortality was 14.0 per 100 000. Both were higher among elderly people, men, and patients resident in areas of greater social deprivation. Overall case fatality was 8.2%. This was higher among those who bled as inpatients after admission for other reasons (42%) and those admitted as tertiary referrals (16%). Factors associated with increased case fatality were age, uraemia, pre-existing malignancy, hepatic failure, hypotension, cardiac failure, and frank haematemesis or a history of syncope at presentation. Social deprivation, sex, and anaemia were not associated with increased case fatality after adjustment for other factors. Conclusions: The incidence of acute upper gastrointestinal haemorrhage was 67% greater than the highest previously reported incidence in the United Kingdom, which may be partially attributable to the greater social deprivation in the west of Scotland and may be related to the increased prevalence of Helicobacter pylori. Fatality after acute upper gastrointestinal haemorrhage was associated with age, comorbidity, hypotension, and raised blood urea concentrations on admission. Although deprivation was associated with increased incidence, it was not related to the risk of fatality. The incidence of upper gastrointestinal haemorrhage in the west of Scotland was 67% higher than the highest incidence previously reported in the United Kingdom A substantial part of this excess incidence may be attributable to socioeconomic deprivation The overall population mortality from upper gastrointestinal haemorrhage may increase as the elderly population increases because both incidence and case fatality rise steeply with age A reduction in the overall case fatality from acute upper gastrointestinal haemorrhage will be best achieved by reducing case fatality among elderly patients

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