P175 Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses, and outcomes in the 2022 UK audit

Introduction

The last UK audit of the management of acute upper gastrointestinal bleeding (AUGIB) was conducted in 2007.¹ We report patient characteristics, investigations, treatments, and clinical outcomes from an interim analysis of the 2022 UK audit.

Methods

Prospective multi-centre observational study of adults (≥16 years) presenting in or to UK hospitals with AUGIB between 3 May and 2 July 2022.

Results

Data on the first 2881 patients (median age 70yr) from 158 participating hospitals are reported. New admissions with AUGIB (n=2205) were younger than inpatients developing AUGIB (median age 68 vs 75 yrs, respectively) with fewer comorbidities (63% vs 79%, respectively). At presentation, 17%(490/2881) had chronic liver disease(CLD), 28%(n=815) a history of alcohol excess, 7%(n=294) were taking non-steroidal anti-inflammatory drugs (NSAID) and 44%(n=1268) antiplatelets or anticoagulants. 80%(n=2315) patients had an inpatient endoscopy; 32%(742/2315) had peptic ulcer disease (PUD), 9%(212/2315) had a variceal bleed, and 27%(622/2315) received endoscopic therapy. Reasons for no endoscopy (n=566) were: 47%(n=265) not clinically indicated/25%(n=139) outpatient procedure/18%(n=102) not for active treatment/6%(n=37) self-discharged/0.5%(n=3) transferred to other hospital/5%(n=28) death. 9%(202/2315) had evidence of further bleeding after index endoscopy. 0.6%(n=19) underwent surgery, 3%(n=72) had interventional radiology (IR) and 47%(n=1367) were transfused ≥1 packed red blood cells (PRC); 4%(n=113) platelets; and 5%(n=137) fresh frozen plasma (FFP) for AUGIB. Median length of stay (LOS) was 5 days. In-hospital mortality was 8.2%(n=636); 5.3% in new admissions and 19% in inpatients. Comparisons with the full 2007 audit are presented in table 1.

Conclusions

Despite an older and more co-morbid population, there is an indication of reduced recurrent bleeding, need for surgery and in-hospital mortality for AUGIB since 2007. This improvement may correlate with improved management and better endoscopic therapy.

Reference

Hearnshaw, et al. Gut 2011.