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

^a Royal College of Physicians and Surgeons of Glasgow, Glasgow G2 5RJ, ^b Glasgow Royal Infirmary NHS Trust, Glasgow G31 2ER, ^c Easterhouse Health Centre, Glasgow G34 9HQ, ^d Department of Public Health, Greater Glasgow Health Board, Glasgow G1 1ET

Correspondence to: Dr O Blatchford Department of Public Health, University of Glasgow, Glasgow G12 8RZ o.blatchford@udcf.gla.uk

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.

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