Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome.

Objectives: In the United States of America and the United Kingdom several epidemiological upper gastrointestinal bleeding (UGIB) surveys have been done. However, information about the current epidemiology of acute UGIB in continental Western Europe is sparse.

Methods: From July of 1993 to July of 1994, 951 patients with acute UGIB were prospectively included in 12 hospitals in the Amsterdam area. Data were collected prospectively with a standard questionnaire and included demographic as well as specific data relating to UGIB.

Results: The overall incidence was 45 per 100,000 persons/yr. Patients had an advanced age (median, 71 yr), and shock was found in 63%. Coexisting illnesses were present in 85%. Twenty percent had a history of previous ulcer disease, of whom 33% used acid suppressive therapy. Endoscopy was performed within 24 h in 78%, and in 42% a gastroduodenal ulcer was found. In 24%, no diagnosis could be made at the initial endoscopy, in these patients endoscopy was done significantly later than in those in whom a diagnosis was readily made. Rebleeding occurred in 16.4%, and 7% had surgery. Mortality rate was 13.9%, which was considered in one-third to be directly related to the bleeding.

Conclusions: The incidence and diagnostic profile of UGIB is similar to other large European studies, but different from those for the United States. Bleeding could perhaps have been prevented in the patients with a history of previous ulcer disease. The 24-h endoscopy service was not as fast, accurate, and widespread as we assumed. Mortality seems to be more related to advanced age, shock, and coexisting illnesses.