Key result
Between 2007 and 2012, the incidence of occult gastrointestinal bleeding increased from 243.1 to 292.8 per 100,000 population, while overt bleeding decreased from 140.1 to 88.0 (P<0.001).
Observational (n=1,169)
p-value: p=<0.001
There is an inverse trend in the incidence of overt versus occult gastrointestinal bleeding, which correlates with the wider use of proton pump inhibitors and NSAIDs/anti-thrombotic therapy.
Rising occult versus falling overt GI bleeding may relate to medication trends; leaves open causal confirmation in prospective studies.
BACKGROUND: While efforts have focused on the prevention of overt upper gastrointestinal bleeding (UGIB), little is known about occult GIB, which might also originate from sites not protected by acid inhibition. AIM: To measure the incidence and outcomes of both overt and occult GIB over a 6-year period (2007-2012), and to assess the use of NSAIDs, anti-thrombotic therapy (ATT), proton pump inhibitors (PPIs), and iron therapy. METHODS: A sample of 300 patients (100 from each of three index years) with occult GIB was randomly selected and their outcomes were compared with those of patients with overt UGIB (N = 869). RESULTS: The incidence of overt UGIB fell from 140.1 per 100 000 population per annum in 2007 to 106.8 in 2010 and to 88.0 in 2012 (P < 0.001); while that of occult GIB rose from 243.1 to 263.6 and to 292.8 (P < 0.001) over the same period. The incidence of occult GIB was highly correlated with the number of prescriptions of PPIs per 1000 population (χ(2) trend = 11.80; P < 0.001). In the overt UGIB group, the median haemoglobin level on presentation was lowest (10.3) in patients taking NSAIDs/ATT plus PPIs compared with those taking PPIs alone (11.5), NSAIDs/ATT alone (10.4) or none of these drugs (12.7 g/dL) (P < 0.001, Kruskal-Wallis). CONCLUSIONS: An inverse trend seems to have formed in the incidence of overt vs. occult gastrointestinal bleeding in association with the wider use of PPIs and NSAIDs. An alternative approach to acid inhibition is needed to prevent gastrointestinal bleeding.
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Taha et al. (2015) conducted an observational in Gastrointestinal bleeding (n=1,169). Occult gastrointestinal bleeding vs. Overt upper gastrointestinal bleeding was evaluated on Incidence of gastrointestinal bleeding per 100,000 population per annum (p=<0.001). Between 2007 and 2012, the incidence of occult gastrointestinal bleeding increased from 243.1 to 292.8 per 100,000 population, while overt bleeding decreased from 140.1 to 88.0 (P<0.001).
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