Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes

Samuel Quan, Alexandra Frolkis, Kaylee Milne, Natalie Molodecky, Hong Yang, Elijah Dixon, Chad G Ball, Robert P Myers, Subrata Ghosh, Robert Hilsden, Sander Veldhuyzen van Zanten, Gilaad G Kaplan

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37 Citations (Scopus)


AIM: To evaluate the incidence, surgery, mortality, and readmission of upper gastrointestinal bleeding (UGIB) secondary to peptic ulcer disease (PUD).

METHODS: Administrative databases identified all hospitalizations for UGIB secondary to PUD in Alberta, Canada from 2004 to 2010 (n = 7079) using the International Classification of Diseases Codes (ICD-10). A subset of the data was validated using endoscopy reports. Positive predictive value and sensitivity with 95% confidence intervals (CI) were calculated. Incidence of UGIB secondary to PUD was calculated. Logistic regression was used to evaluate surgery, in-hospital mortality, and 30-d readmission to hospital with recurrent UGIB secondary to PUD. Co-variants accounted for in our logistic regression model included: age, sex, area of residence (i.e., urban vs rural), number of Charlson comorbidities, presence of perforated PUD, undergoing upper endoscopy, year of admission, and interventional radiological attempt at controlling bleeding. A subgroup analysis (n = 6356) compared outcomes of patients with gastric ulcers to those with duodenal ulcers. Adjusted estimates are presented as odds ratios (OR) with 95%CI.

RESULTS: The positive predictive value and sensitivity of ICD-10 coding for UGIB secondary to PUD were 85.2% (95%CI: 80.2%-90.2%) and 77.1% (95%CI: 69.1%-85.2%), respectively. The annual incidence between 2004 and 2010 ranged from 35.4 to 41.2 per 100000. Overall risk of surgery, in-hospital mortality, and 30-d readmission to hospital for UGIB secondary to PUD were 4.3%, 8.5%, and 4.7%, respectively. Interventional radiology to control bleeding was performed in 0.6% of patients and 76% of these patients avoided surgical intervention. Thirty-day readmission significantly increased from 3.1% in 2004 to 5.2% in 2010 (OR = 1.07; 95%CI: 1.01-1.14). Rural residents (OR rural vs urban: 2.35; 95%CI: 1.83-3.01) and older individuals (OR ≥ 65 vs < 65: 1.57; 95%CI: 1.21-2.04) were at higher odds of being readmitted to hospital. Patients with duodenal ulcers had higher odds of dying (OR = 1.27; 95%CI: 1.05-1.53), requiring surgery (OR = 1.73; 95%CI: 1.34-2.23), and being readmitted to hospital (OR = 1.54; 95%CI: 1.19-1.99) when compared to gastric ulcers.

CONCLUSION: UGIB secondary to PUD, particularly duodenal ulcers, was associated with significant morbidity and mortality. Early readmissions increased over time and occurred more commonly in rural areas.

Original languageEnglish
Pages (from-to)17568-17577
Number of pages10
JournalWorld Journal of Gastroenterology
Issue number46
Publication statusPublished - 14 Dec 2014


  • Adult
  • Aged
  • Alberta
  • Databases, Factual
  • Duodenal Ulcer
  • Female
  • Hemostatic Techniques
  • Hospital Mortality
  • Humans
  • Incidence
  • International Classification of Diseases
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Readmission
  • Peptic Ulcer Hemorrhage
  • Prospective Studies
  • Recurrence
  • Risk Factors
  • Rural Health
  • Stomach Ulcer
  • Time Factors
  • Treatment Outcome
  • Urban Health
  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Validation Studies


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