Background and Goals

Peptic ulcer disease is the most frequent cause of upper gastrointestinal bleeding. We sought to establish the epidemiology and hemostasis success rate of the different treatment modalities in this setting.

Methods

Retrospective cohort study using the National Inpatient Sample. Non-elective adult admissions with a principal diagnosis of ulcer bleeding were included. The primary outcome was endoscopic, radiologic and surgical hemostasis success rate. Secondary outcomes were patients’ demographics, in-hospital mortality and resource utilization. On subgroup analysis, gastric and duodenal ulcers were studied separately. Confounders were adjusted for using multivariate regression analysis.

Results

A total of 136,425 admissions (55% gastric and 45% duodenal ulcers) were included. The mean patient age was 67 years. The majority of patients were males, Caucasians, of lower income and high comorbidity burden. The endoscopic, radiological and surgical therapy and hemostasis success rates were 33.6, 1.4, 0.1, and 95.1%, 89.1 and 66.7%, respectively. The in-hospital mortality rate was 1.9% overall, but 2.4% after successful and 11.1% after failed endoscopic hemostasis, respectively. Duodenal ulcers were associated with lower adjusted odds of successful endoscopic hemostasis, but higher odds of early and multiple endoscopies, endoscopic therapy, overall and successful radiological therapy, in-hospital mortality, longer length of stay and higher total hospitalization charges and costs.

Conclusions

The ulcer bleeding endoscopic hemostasis success rate is 95.1%. Rescue therapy is associated with lower hemostasis success and more than a ten-fold increase in mortality rate. Duodenal ulcers are associated with worse treatment outcomes and higher resource utilization compared with gastric ulcers.

中文翻译：

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美国的溃疡出血：流行病学、治疗成功和资源利用

背景和目标

消化性溃疡病是上消化道出血的最常见原因。我们试图确定这种情况下不同治疗方式的流行病学和止血成功率。

方法

使用全国住院患者样本进行回顾性队列研究。包括主要诊断为溃疡出血的非选择性成人入院。主要结局是内窥镜、放射学和手术止血的成功率。次要结果是患者的人口统计数据、院内死亡率和资源利用率。在亚组分析中，胃溃疡和十二指肠溃疡分别进行了研究。使用多元回归分析调整混杂因素。

结果

总共纳入了 136,425 例入院患者（55% 为胃溃疡，45% 为十二指肠溃疡）。患者平均年龄为 67 岁。大多数患者是男性、白人，收入较低且合并症负担较高。内镜、放射、手术治疗和止血成功率分别为33.6%、1.4%、0.1%、95.1%、89.1%和66.7%。院内死亡率总体为 1.9%，但内镜止血成功后死亡率为 2.4%，失败后死亡率为 11.1%。十二指肠溃疡与内镜止血成功的调整后几率较低相关，但早期和多次内镜检查、内镜治疗、全面和成功的放射治疗、院内死亡率、住院时间较长以及住院总费用和费用较高的几率相关。

结论

溃疡出血内镜下止血成功率为95.1%。抢救治疗会导致止血成功率降低和死亡率增加十倍以上。与胃溃疡相比，十二指肠溃疡的治疗结果较差，资源利用率较高。