Author(s): Barkun A, Sabbah S, Enns R, Armstrong D, Gregor J,
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Abstract OBJECTIVES: From the Canadian Registry of patients with Upper Gastrointestinal Bleeding and Endoscopy (RUGBE), we determined clinical outcomes and explored the roles of endoscopic and pharmacologic therapies in a contemporary real-life setting. METHODS: Analysis of randomly selected patients endoscoped for nonvariceal upper gastrointestinal bleeding at 18 community and tertiary care institutions between 1999 and 2002. Covariates and outcomes were defined a priori and 30-day follow-up obtained. Logistic regression models identified predictors of outcomes. RESULTS: One thousand eight-hundred and sixty-nine patients were included (66 +/- 17 yr, 38\% female, 2.5 +/- 1.6 comorbid conditions, hemoglobin, 96 +/- 27 g/L, 54\% received a mean of 2.9 +/- 1.7 units of blood). Endoscopy was performed within 24 h in 76\%, with ulcers (55\%) most commonly noted. High-risk endoscopic stigmata and endoscopic therapy were reported in 37\%. Rebleeding, surgery, and mortality rates were 14.1\%, 6.5\%, and 5.4\%, respectively. Decreased rebleeding was significantly and independently associated with PPI use (85\% of patients, mean daily dose 56 +/- 53 mg) in all patients regardless of endoscopic stigmata, (odds ratio (OR):0.53, 95\% confidence interval, 95\% CI:0.37-0.77) and endoscopic hemostasis in patients with high-risk stigmata (OR:0.39, 95\% CI:0.25-0.61). PPI use (OR:0.18, 95\% CI:0.04-0.80) and endoscopic therapy (OR:0.31, 95\% CI:0.11-0.91) were also each independently associated with decreased mortality in patients with high-risk stigmata. CONCLUSIONS: These results appear to confirm the protective role of endoscopic therapy in patients with high-risk stigmata, and suggest that acute use of PPIs may be associated with a reduction of rebleeding in all patients, and lower mortality in patients with high-risk stigmata. Independent prospective validation of these observational findings is now required.
This article was published in Am J Gastroenterol
and referenced in Journal of Liver