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Neue Epidemiologie der akuten gastrointestinalen Blutung

New epidemiology of acute gastrointestinal hemorrhage

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Zusammenfassung

Die allgemeinen medizinischen, noch mehr aber die gastroenterologischen Fortschritte der letzten 25 Jahre würden erwarten lassen, dass gastrointestinale Blutungen seltener und deren Letalität heute geringer sind. Die publizierten epidemiologischen Daten können dies insgesamt nicht oder nicht im erhofften Ausmaß bestätigen. Die Datenqualität vieler Studien ist aber unbefriedigend. So scheint es beispielsweise, dass fragwürdige Blutungsquellen wie Erosionen im oberen Gastrointestinaltrakt und Kolondivertikel oft wenig kritisch als definitive Ursache der Blutung bezeichnet werden. Klare Hinweise auf Veränderungen finden sich jedoch in Untergruppen. Nach dem Rückgang von H. pylori in der jüngeren Bevölkerung sind bei der Ulkusblutung heute vermehrt ältere Personen mit zusätzlichen Risikofaktoren wie schwerwiegenden Begleiterkrankungen sowie Einnahme von NSAR, Low-dose-Aspirin und Antikoagulantien betroffen. Nicht unerwartet findet sich in dieser Gruppe generell keine Veränderung oder sogar eine Verschlechterung der Prognose bei akuter Blutung.

Abstract

Due to progress in general medicine and especially in gastroenterology, the incidence of acute gastrointestinal hemorrhage could be expected to have decreased during the last 25 years. However, published epidemiological data cannot, in general, fulfill this hope. The interpretation of potential trends is, however, often limited by low study quality. For example, questionable bleeding sources such as erosions in the upper gastrointestinal tract or colon diverticula are often rather uncritically named the definitive causes of bleeding. However, there is clear evidence of changes in grouping of patients. After the almost complete disappearance of Helicobacter pylori in younger indigenous populations of most industrialized countries, it is mostly elderly comorbid people with additional risk factors (NSAID use, low-dose aspirin, anticoagulation) who are affected. Not unexpectedly, this group has generally experienced no change in incidence and in fact shows a deterioration of prognosis in case of acute bleeding.

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Literatur

  1. Alexander-Williams J (1991) A requiem for vagotomy. Despite the last ditch efforts of surgeons (editorial). BMJ 302:547–548

    PubMed  Google Scholar 

  2. Andriulli A, Annese V, Caruso N et al. (2005) Proton-pump inhibitors and outcome of endoscopic hemostasis in bleeding peptic ulcers: a series of meta-analyses. Am J Gastroenterol 100:207–219

    Article  PubMed  Google Scholar 

  3. Bak Andersen I, Bonnevie O, Jörgensen T, Sörensen TIA (1998) Time trends for peptic ulcer disease in Denmark, 1981–1993. Scand J Gastroenterol 33:260–266

    Article  PubMed  Google Scholar 

  4. Bardhan KD, Cust G, Hinchliffe RF, Williamson FM, Lyon C, Bose K (1989) Changing pattern of admissions and operations for duodenal ulcer. Br J Surg 76:230–236

    PubMed  Google Scholar 

  5. Battistella M, Mamdami MM, Juurlink DN, Rabeneck L, Laupacis A (2005) Risk of upper gastrointestinal hemorrhage in warfarin users treated with nonselective NSAIDs or COX-2 inhibitors. Arch Intern Med 165:189–192

    Article  PubMed  Google Scholar 

  6. Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J (1997) Acute upper gastrointestinal haemorrhage in west of Scotland: case ascertainment study. BMJ 315:510–514

    PubMed  Google Scholar 

  7. Bode G, Rothenbacher D, Brenner H, Adler G (1998) Variation in the13C-urea breath test value by nationality in Helicobacter pylori-infected children. Scand J Gastroenterol 33:468–472

    Article  PubMed  Google Scholar 

  8. Boltshauser S, Herzog D (1999) Prävalenz der asymptomatischen Helicobacter-Infektion bei den 5–7-jährigen Kindern des Kantons St. Gallen. Schweiz Med Wochenschr 129:579–584

    PubMed  Google Scholar 

  9. Boonpongmanee S, Fleischer DE, Pezzullo JC et al. (2004) The frequency of peptic ulcer as a cause of upper-GI bleeding is exaggerated. Gastrointest Endosc 59:788–794

    Article  PubMed  Google Scholar 

  10. Boulay F, Berthier F, Dahan MDC, Tran A (2001) Seasonal variations in variceal bleeding mortality and hospitalization in France. Am J Gastroenterol 96:1881–1887

    Article  PubMed  Google Scholar 

  11. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R (2004) Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology 40:652–659

    Article  PubMed  Google Scholar 

  12. Chan HL, Wu JC, Chan FK et al. (2001) Is non-Helicobacter pylori, non-NSAID peptic ulcer a common cause of upper GI bleeding? A prospective study of 977 patients. Gastrointest Endosc 53:438–442

    Article  PubMed  Google Scholar 

  13. Chow LW, Gertsch P, Poon RT, Branicki FJ (1998) Risk factors for rebleeding and death from peptic ulcer in the very elderly. Br J Surg 85:121–124

    Article  PubMed  Google Scholar 

  14. Christensen A, Bousfield R, Christiansen J (1988) Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2-receptor antagonists. Ann Surg 207:4–6

    PubMed  Google Scholar 

  15. Cutler JA, Mendeloff AI (1981) Upper gastrointestinal bleeding. Nature and magnitude of the problem in the U.S. Dig Dis Sci 26:90S-96S

    Article  PubMed  Google Scholar 

  16. Czernichow P, Hochain P, Nousbaum JB et al. (2000) Epidemiology and course of acute upper gastro-intestinal haemorrhage in four French geographical areas. Eur J Gastroenterol Hepatol 12:175–181

    PubMed  Google Scholar 

  17. Derry S, Loke YK (2000) Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. BMJ 321:1183–1187

    Article  PubMed  Google Scholar 

  18. Di Fiore F, Leclaire S, Merle V et al. (2005) Changes in characteristics and outcome of acute upper gastrointestinal haemorrhage: a comparison of epidemiology and practices between 1996 and 2000 in a amulticentre French study. Eur J Gastroenterol Hepatol 17:86–87

    Google Scholar 

  19. Dorta G, Jornod P, Blum AL, Grehn M, Gassner M (1999) Low prevalence of Helicobacter pylori infection in Swiss adolescents. Helicobacter 4:67

    Article  PubMed  Google Scholar 

  20. El-Serag HB, Everhart JE (2000) Improved survival after variceal hemorrhage over an 11-year period in the Department of Veterans Affairs. Am J Gastroenterol 95:3566–3573

    Article  PubMed  Google Scholar 

  21. Elashoff JD, Grossman MI (1980) Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978. Gastroenterology 78:280–285

    PubMed  Google Scholar 

  22. Farrell JJ, Friedman LS (2005) Review article: the management of lower gastrointestinal bleeding. Aliment Pharmacol Ther 21:1281–1298

    Article  PubMed  Google Scholar 

  23. Gisbert JP, Gonzalez L, de Pedro A et al. (2001) Helicobacter pylori and bleeding duodenal ulcer: prevalence of the infection and role of non-steroidal anti-inflammatory drugs. Scand J Gastroenterol 36:717–724

    Article  PubMed  Google Scholar 

  24. Green BT, Rockey DC, Portwood G et al. (2005) Urgent colonoscopy for evaluation and management of acute lower gastrointestinal heamorrhage: A randomized controlled trial. Am J Gastroenterol 100:2395–2402

    Article  PubMed  Google Scholar 

  25. Grimm W, Fischbach W (2003) Helicobacter pylori-Infektion bei Kindern und Jugendlichen. Eine epidemiologische Untersuchung zu Pravalenz, soziookonomischen Faktoren und Beschwerdebild. Dtsch Med Wochenschr 128:1878–1883

    Article  PubMed  Google Scholar 

  26. Hernandez-Diaz S, Rodriguez LA (2002) Incidence of serious upper gastrointestinal bleeding/perforation in the general population: review of epidemiologic studies. J Clin Epidemiol 55:157–163

    Article  PubMed  Google Scholar 

  27. Higham J, Kang JYMA (2002) Recent trends in admission and mortality due to peptic ulcer in England: Increasing frequency of haemorrhage among older subjects. Gut 50:460–464

    Article  PubMed  Google Scholar 

  28. Jensen DM, Machicado GA, Jutabha R, Kovacs TO (2000) Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 342:78–82

    Article  PubMed  Google Scholar 

  29. Jensen DM, Mawas I, Lousuebsakul V, Fontana L, St Amand A (2003) Changes in the prevalence of different diagnosies for UGI hemorrhage in the last two decades (abstract). Gastrointest Endosc 57:AB147

    Google Scholar 

  30. Jibril JA, Redpath A, Macintyre IM (1994) Changing pattern of admission and operation for duodenal ulcer in Scotland. Br J Surg 81:87–89

    PubMed  Google Scholar 

  31. Kapur KC, Green JT, Turner RG, Swift J, Srivastava ED, Allison MC (1998) Auditing mortality from upper gastrointestinal haemorrhage: impact of a high dependency unit. J R Coll Physicians Lond 32:246–250

    PubMed  Google Scholar 

  32. Keuchel M, Hagenmüller F (2005) Small bowel endoscopy. Endoscopy 37:122–132

    Article  PubMed  Google Scholar 

  33. Kurata JH, Honda GD, Frankl H (1982) Hospitalization and mortality rates for peptic ulcers: a comparison of a large health maintenance organization and United States data. Gastroenterology 83:1008–1016

    PubMed  Google Scholar 

  34. Laine L, Maller ES, Yu C, Quan H, Simon T (2004) Ulcer formation with low-dose enteric-coated aspirin and the effect of COX-2 selective inhibition: a double-blind trial. Gastroenterology 127:395–402

    Article  PubMed  Google Scholar 

  35. Leontiadis GI, Sharma VK, Howden CW (2005) Systematic review and meta-analysis of proton pump inhibitor therapy in peptic ulcer bleeding. BMJ 330:568

    Article  PubMed  Google Scholar 

  36. Leontiadis GI, Sharma VK, Howden CW (2005) Systematic review and meta-analysis: enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia — a post hoc analysis from the Cochrane Collaboration. Aliment Pharmacol Ther 21:1055–1061

    Article  PubMed  Google Scholar 

  37. Lewis JD, Bilker WB, Brensinger C, Farrar JT, Strom BL (2002) Hospitalization and mortality rates from peptic ulcer disease and GI bleeding in the 1990 s: relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medications. Am J Gastroenterol 97:2540–2549

    Article  PubMed  Google Scholar 

  38. Lim CH, Heatley RV (2005) Prospective study of acute gastrointestinal bleeding attributable to anti-inflammatory drug ingestion in the Yorkshire region of the United Kingdom. Postgrad Med J 81:252–254

    Article  PubMed  Google Scholar 

  39. Longstreth GF (1997) Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 92:419–424

    PubMed  Google Scholar 

  40. Longstreth GF (1995) Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol 90:206–210

    PubMed  Google Scholar 

  41. Mamdani M, Juurlink DN, Kopp A, Naglie G, Austin PC, Laupacis A (2004) Gastrointestinal bleeding after the introduction of COX-2 inhibitors: ecological study. BMJ 328:1415–1416

    Article  PubMed  Google Scholar 

  42. Marmo R, Botondano G, Piscopo R, Bianco MA, Cipolletta L (2005) Meta-analysis: capsule enteroscopy vs. conventional modalities in diagnosis of small bowel diseases. Aliment Pharmacol Ther 22:595–604

    Article  PubMed  Google Scholar 

  43. Morgan AG, Clamp SE (1988) OMGE international upper gastrointestinal bleeding survey, 1978–1986. Scand J Gastroenterol [Suppl] 144:51–58

    Google Scholar 

  44. Newman JR, Cooper MA (2002) Lower gastrointestinal bleeding and ischemic colitis. Can J Gastroenterol 16:597–600

    PubMed  Google Scholar 

  45. Nousbaum JB, Hochain P, Kerjean A et al. (1999) Les ulcères oeso-gastro-duodenaux hémorragiques: épidemiologie et prise en charge. Etude prospective multicentrique. Ann Chir 53:942–948

    PubMed  Google Scholar 

  46. Ofman JJ, MacLean CH, Straus WL, Morton SC, Berger ML, Roth EA, Shekelle P (2002) A metaanalysis of severe upper gastrointestinal complications of nonsteroidal antiinflammatory drugs. J Rheumatol 29:804–812

    PubMed  Google Scholar 

  47. Ohmann C, Imhof M, Ruppert C et al. (2005) Time-trends in the epidemiology of peptic ulcer bleeding. Scand J Gastroenterol 40:914–920

    Article  PubMed  Google Scholar 

  48. Paimela H, Oksala NK, Kivilaakso E (2004) Surgery for peptic ulcer today. A study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg 21:185–191

    Article  PubMed  Google Scholar 

  49. Paton C, Ferrier IN (2005) SSRIs and gastrointestinal bleeding. BMJ 331:529–530

    Article  PubMed  Google Scholar 

  50. Penston JG, Crombie IK, Waugh NR, Wormsley KG (1993) Trends in morbidity and mortality from peptic ulcer disease: Tayside versus Scotland. Aliment Pharmacol Ther 7:429–442

    PubMed  Google Scholar 

  51. Prakash C, Zuckerman GR (2003) Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations. Gastrointest Endosc 58:330–335

    Article  PubMed  Google Scholar 

  52. Ridker PM, Cook NR, Lee IM et al. (2005) A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 352:1293–1304

    Article  PubMed  Google Scholar 

  53. Rios A, Montoya MJ, Rodriguez JM, Serrano A, Molina J, Parrilla P (2005) Acute lower gastrointestinal hemorrhages in geriatric patients. Dig Dis Sci 50:898–904

    Article  PubMed  Google Scholar 

  54. Rockall TA, Logan RF, Devlin HB, Northfield TC (1995) Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ 311:222–226

    PubMed  Google Scholar 

  55. Rockall TA, Logan RF, Devlin HB, Northfield TC (1995) Variation in outcome after acute upper gastrointestinal haemorrhage. The National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet 346:346–350

    Article  PubMed  Google Scholar 

  56. Sam C, Massaro JM, D’Agostino RB Sr, Levy D, Lambert JW, Wolf PA, Benjamin EJ (2004) Warfarin and aspirin use and the predictors of major bleeding complications in atrial fibrillation (the Framingham Heart Study). Am J Cardiol 94:947–951

    Article  PubMed  Google Scholar 

  57. Sonnenberg A (1995) Temporal trends and geographical variations of peptic ulcer disease. Aliment Pharmacol Ther 9 Suppl 2:3–12

    Google Scholar 

  58. Svanes C (2000) Trends in perforated peptic ulcer: Incidence, etiology, treatment, and prognosis. World J Surg 24:277–283

    Article  PubMed  Google Scholar 

  59. Taha AS, Angerson WJ, Naur S, Knill-Jones RP, Blatchford O (2005) Upper gastrointestinal haemorrhage associated with low-dose aspirin and anti-thrombotic drugs—a six-year epidemiological analysis and comparison with non-steroidal anti-inflammatory drugs. Gastroenterology 128 [Suppl 2]:A-154

  60. Tilvis RS, Vuoristo M, Varis K (1987) Changed profile of peptic ulcer disease in hospital patients during 1969–1984 in Finland. Scand J Gastroenterol 22:1238–1244

    PubMed  Google Scholar 

  61. Triester SL, Leighton JA, Leontiadis GI et al. (2005) A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 100:2407–2418

    Article  PubMed  Google Scholar 

  62. Van Leerdam ME, Vreeburg EM, Rauws EA, Geraedts AA, Tijssen JG, Reitsma JB, Tytgat GN (2003) Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol 98:1494–1499

    PubMed  Google Scholar 

  63. Vreeburg EM, de Bruijne HW, Snel P, Bartelsman JW, Rauws EA, Tytgat GN (1997) Previous use of non-steroidal anti-inflammatory drugs and anticoagulants: the influence on clinical outcome of bleeding gastroduodenal ulcers. Eur J Gastroenterol Hepatol 9:41–44

    PubMed  Google Scholar 

  64. Vreeburg EM, Snel P, de Bruijne JW, Bartelsman JFWM, Rauws EAJ, Tytgat GNJ (1997) Acute upper gastrointestinal bleeding in the Amsterdam area: Incidence, diagnosis, and clinical outcome. Am J Gastroenterol 92:236–243

    PubMed  Google Scholar 

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Der korrespondierende Autor ist Consultant bei AstraZeneca Schweiz. Andere Verbindungen mit einem hier genannten Produkt oder einem Konkurrenzprodukt bestehen nicht. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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  1. Abteilung für Gastroenterologie, Medizinische Klinik, Stadtspital Triemli Zürich

    H.-R. Koelz & M. Arn

  2. Abteilung für Gastroenterologie, Medizinische Klinik, Stadtspital Triemli, Birmensdorferstrasse 497, CH-8063 , Zürich

    H.-R. Koelz

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Koelz, HR., Arn, M. Neue Epidemiologie der akuten gastrointestinalen Blutung. Chirurg 77, 103–110 (2006). https://doi.org/10.1007/s00104-005-1142-7

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