1. Non-Variceal Upper GI Bleeding in Patients Already Hospitalized for Another Condition
Tanja Muller, MD, Alan N. Barkun, MD, CM, MSc, Myriam Martel , BSc and the RUGBE investigators
Am J Gastroenterol 2009;104:330–339
R3 Ju-Woong Son/Prof. Jae-Young Jang

2. INTRODUCTION Acute upper gastrointestinal bleeding Earlier studies
170 cases per 100,000 adults per year
Earlier studies
patients presenting to the emergency room with non-variceal upper gastrointestinal bleeding (NVUGIB)
only few have focused on the development of NVUGIB that occurs after hospital admission

3. INTRODUCTION The aim of this study
to analyze and compare differences in the baseline characteristics between patients having started to bleed as outpatients (OPs) and patients already hospitalized for another reason (inpatients, IPs)

4. METHODS Patient population Between September 1999 and December 2001
1,878 patients presented with a history of hematemesis / coffee-ground vomiting, melena, hematochezia
Outpatients (OPs)
A patient presenting to a medical facility because of a new onset of NVUGIB
Inpatients (IPs)
a patient developing NVUGIB while already hospitalized for an unrelated illness
Exclusion
esophageal, gastric, or duodenal varices

5. METHODS The observed outcomes the occurrence of continued bleeding
Rebleeding
Surgery
transfusion requirements
length of hospital stay
mortality

6. RESULTS

8. Outpatients total (n=1395)
Initial management
Inpatients total
(n=469)
Outpatients total (n=1395)
P value
Mean (median)
Resuscitation with
IV fluid
70%
81%
P<0.001
Hemodynamic instability
29%
33% NS
Transfusion
3.0±1.9U
2.9±1.6U
57%
54%

9. Timing of endoscopy following admission/onset of bleeding
The first 24 h after onset of bleeding
- 60% of IPs compared with 82% of OPs (p<0.001)

10. Comparison of endoscopic findings in in- and outpatients
The combined proportions of ulcers and erosions
- 83% of IPs compared with 85% of OPs (p=0.314)

11. Outpatients total (n=1395)
Pharmacotherapy
Inpatients total
(n=469)
Outpatients total (n=1395)
P value
Mean (median)
First dose of medication
8.3±13.4h
11.5±17.6h
PPI
88%
83%
P=0.009
Mean daily doses of PPI
57±58mg
57±52mg NS
H2 blocker
23%
25%
PPI & H2 blocker
19%
Endoscopic Tx and medication
37%
33%
P=0.169

12. Outpatients total (n=1395)
H. Pylori treatment
Inpatients total (n=469)
Outpatients total (n=1395)
P value
Mean (median)
Prior diagnosis of
H. Pylori
0.9%
4.4%
P<0.001
H. Pylori infection
35%
51%
Gastroduodenal ulcer
35.4%
47%
Eradiacation therapy (initiated in hospital)
8.6%
10%
P=0.278
62.2±47h
73±130h

13. Outpatients total (n=1395)
Outcomes
Inpatients total (n=469)
Outpatients total (n=1395)
P value
Mean (median)
Length of hospital stay
7.2±7.4day
5±5.4day
P<0.001
ICU
40.5%
16%
Continued bleeding or Rebleeding
15.7%
13.4%
P=0.227
Surgery
6.9%
6.4%
P=0.717
Mortality
11%
3.5%

17. Conclusion
IPs developing NVUGIB are much sicker and are hospitalized longer than OPs.
Endoscopic hemostasis and PPI therapy favorably affect rebleeding in IPs, whereas patient characteristics principally determine the threefold greater IPs mortality.