By David Wild

Las Vegas—The past two decades have seen a 50% drop in the number of deaths due to upper gastrointestinal hemorrhage (UGIH), with a coinciding increase in inpatient endoscopies in those individuals, according to epidemiologic findings presented at the 2012 American College of Gastroenterology annual scientific meeting (abstract 2). Although the researchers could not establish a causal link between the two variables, they believe that wider use of diagnostic and therapeutic inpatient endoscopies, along with improved UGIH-specific medical treatment, has played a substantial role in lowering rates of UGIH-related mortality.

Sravanthi Parasa, MBBS, an expert in UGI bleeding, of the Department of Internal Medicine at the University of Kansas Medical Center, Kansas City, believes that gastroenterologists and endoscopists should pride themselves on heading off inpatient deaths among individuals with UGIH.

“This is a very strong study and the findings are reliable, especially because the data were drawn from a nationally representative and validated database,” said Dr. Parasa, who was not involved in the research.

Marwan Abougergi, MD, and John Saltzman, MD, researchers in the Division of Gastroenterology at Brigham and Women’s Hospital, Harvard Medical School, in Boston, analyzed information from the Nationwide Inpatient Sample (NIS) collected between 1989 and 2009, dividing the data into five-year intervals. They used International Classification of Diseases (ICD)-9 codes to identify primary diagnoses of UGIH.

Their analysis revealed the incidence of UGIH began decreasing in 1994, from 83 cases per 100,000 Americans in that year to 78 cases per 100,000 Americans in 2009. Rates of inpatient mortality among UGIH patients also dropped, from 4.69% in 1989 to 2.13% in 2009 (Table).

Table. Trends in UGIH-Related Mortality, Endoscopy Use
1989 1994 1999 2004 2009
Mortality among inpatients with UGI hemorrhage 4.69% 3.34% 2.93% 2.43% 2.13%
Total inpatient endoscopy rate 69% 80% 85% 86% 85%
Therapeutic endoscopies as a percentage of total inpatient endoscopies 2% 18% 22% 23% 27%
UGIH, upper gastrointestinal hemorrhage

The combined use of diagnostic and therapeutic endoscopy increased from 69% to 85% over the study period. As a proportion of all inpatient endoscopies, the percentage of therapeutic endoscopies rose dramatically, from 2% of all UGIH-related inpatient endoscopies in 1989 to 27% in 2009, they found.

Dr. Abougergi also reported the proportion of endoscopies performed within 24 hours of admission increased from 23% in 1989 to 54% in 2009. This might partially account for the drop in hospital lengths of stay from 4.52 days in 1989 to 2.85 days in 2009, he said.

One finding that surprised the researchers was that, despite the shorter hospital stays, the average inflation-adjusted cost of treating a patient with UGIH has risen sharply, from $9,249 in 1989 to $20,370 in 2009.

“Although we are not sure why this is, we think it reflects the general increase in per-day hospitalization charges,” Dr. Abougergi said. “Those can be driven by charges for room and board, or charges for the increasingly more costly medications used during treatment, among others.”

Dr. Parasa observed that Charlson comorbidity index scores in the analysis increased, from 0.68 in 1989 to 0.93 in 2009.

“The results are particularly impressive given that rates of UGIH-related deaths have dropped, despite an increased number of comorbidities,” she said.