ANALYSIS OF 3,294 CASES OF UPPER GASTROINTESTINAL-BLEEDING IN MILITARY MEDICAL FACILITIES

Objectives: Upper gastrointestinal bleeding (UGIB) remains a commonly encountered medical emergency with significant morbidity and mortality . Most large studies detailing the specific incidence, demographic, an d mortality data were performed more than a decade ago. This study ana lyzes 3,294 cases of UGIB from 139 military medical treatment faciliti es over a 12-month period. Methods: A retrospective chart review of De partment of Defense military medical treatment facilities for UGIB was performed from October 1990 through September 1991. Core data such as demographic information were analyzed, as well as specific data relat ing to UGIB. Results: The incidence of UGIB was 36 per 100,000 populat ion with a male-to-female ratio of 2.18 and a mean age of 52 +/- 19.65 yr. The number of cases increased with age; 44.5% of all patients wer e greater than or equal to 60 yr old. The overall mortality was 7.0% ( 231 of 3294), and death rates were similar among males and females (7. 1% vs. 6.8%) with an odds ratio of 1.03 (CI: 0.77-1.402). Mortality in creased with age in both genders; 73.2% of deaths occurred in patients more than 60 yr old. Comorbid illness was noted in 50.9% (1675 of 329 4) of patients, with similar occurrence in males (48.7%) and females ( 55.4%). One or more comorbid illnesses were noted in 98.3% of the pati ents who died, and in 72.3% of cases, they were the primary cause of d eath. Bleeding was the primary cause of death in 18.6% of patients. Up per endoscopy was performed in 68.8% of cases, therapeutic endoscopy i n 12.6%, repeat endoscopy in 10.7%, and surgery in 4.4%. Blood transfu sions were administered in 47.3% of cases, with most patients receivin g < 5 units of blood. Rebleeding after initial hemostasis was noted in 7.1% of cases. Factors related to increased mortality include age > 6 0 (p < 0.001), transfusion requirement > 5 U (p < 0.001), presence of comorbid illness (p < 0.001), rebleeding after initial hemostasis (p < 0.005), surgery (p < 0.001), and UGIB occurring during hospitalizatio n (p = 0.027). Conclusions: We conclude: 1) The incidence of UGIB is 2 -fold greater in males than in females, in all age groups; however, th e death rate is similar in both sexes. 2) The mortality rate in this s tudy is slightly lower than in most previous studies and may be more r eflective of the average mortality in the community at large. 3) In UG IB patients, comorbid illness and not actual bleeding is the major cau se of death. 4) Upper endoscopy was performed less often in this study than in other studies, and there were fewer blood transfusions; howev er, rebleeding and mortality rates remained similar.