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Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization

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An Invited Commentary to this article was published on 06 March 2024

Abstract

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.

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Data availability

Marwan S. Abougergi accepts full responsibility for the conduct of the study. He has had access to the data and has control of the decision to publish.

Abbreviations

NSAIDS:

Non-steroidal anti-inflammatory drugs

NIS:

National Inpatient Sample

AHRQ:

Agency for healthcare research and quality

HCUP:

Healthcare cost and utilization project

ICD-10 CM:

International classification of diseases, 10th revision, clinical modification

aOR:

Adjusted odds ratio

aMD:

Adjusted mean difference

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Authors and Affiliations

  1. Department of Internal Medicine, Prisma Health Midlands, Columbia, SC, USA

    Hata Mujadzic, Shayan Noorani & Philip J. Riddle

  2. University of South Carolina School of Medicine, Columbia, SC, USA

    Hata Mujadzic, Shayan Noorani & Philip J. Riddle

  3. Mercy Internal Medicine Service, Trinity Health of New England, Springfield, MA, USA

    Yichen Wang

  4. Department of Health Sciences, Clemson University, Clemson, SC, USA

    Gracelyn Metts & Tania Yacu

  5. Catalyst Medical Consulting, Huntingdon Valley, PA, USA

    Marwan S. Abougergi

  6. Division of Gastroenterology, Department of Internal Medicine, INOVA Fairfax Hospital, INOVA Health, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Marwan S. Abougergi

Authors
  1. Hata Mujadzic
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  2. Shayan Noorani
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  3. Philip J. Riddle
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  4. Yichen Wang
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Contributions

HM and SN: planning the study, interpreting data, drafting the manuscript. PJR and YW: planning the study, drafting the manuscript. GM and TY: drafting the manuscript. MSA: planning the study, collecting/extracting the data, interpreting data, drafting the manuscript.

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Correspondence to Marwan S. Abougergi.

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Mujadzic, H., Noorani, S., Riddle, P.J. et al. Ulcer Bleeding in the United States: Epidemiology, Treatment Success, and Resource Utilization. Dig Dis Sci (2024). https://doi.org/10.1007/s10620-024-08322-y

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