Mortality With Upper Gastrointestinal Bleeding and Perforation: Effects of Time and NSAID Use

Sebastian Straube; Martin R Tramèr; R. Andrew Moore; Sheena Derry; Henry J. McQuay

BMC Gastroenterol

Conclusion

Upper gastrointestinal bleed or perforation still carries a finite risk of death. Differences in study architecture, population characteristics, risk factors, definition of mortality, and reporting of outcomes impose limitations on interpreting effect size. Data published since 1997 suggest that overall mortality in any patient with a bleed or perforation has fallen over time but is still about 1 in 13. Not unexpectedly, mortality is even higher in patients with a bleed or perforation who are exposed to NSAID or aspirin. New knowledge is that in these patients, mortality appears to have increased over time to about 1 in 5 since 1997. Reasons for this increase remain to be elucidated.

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Acknowledgments

Pain Research is supported in part by the Oxford Pain Research Trust, which had no role in design, planning, execution of the study, or in writing the manuscript.

Reprint Address

Sebastian Straube, Email: sebastian.straube@googlemail.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Cite this: Mortality With Upper Gastrointestinal Bleeding and Perforation: Effects of Time and NSAID Use - Medscape - Jun 01, 2009.

Table 1. Mortality Rates in Cases of Upper Gastrointestinal Bleed or Perforation According to Date of Publication and Size of Study, For All Cases and Those Taking NSAID
Analysis	All Cases			Cases using NSAIDs
	Number of		Mortality (%; 95% CI)	Number of		Mortality (%; 95% CI)
	Cases	Deaths	Mortality (%; 95% CI)	Cases	Deaths	Mortality (%; 95% CI)
Overall	61067	5001	8.2 (8.0 to 8.4)	5526	904	16.4 (15.4 to 17.3)
By date of publication
Before 1997^[1]	11361	1319	11.6 (11.0 to 12.2)	4046	595	14.7 (13.6 to 15.8)
Between 1997 and 2008	49706	3682	7.4 (7.2 to 7.6)	1480	309	20.9 (18.8 to 22.9)
By number of cases
≥ 2000	35058	2410	6.9 (6.6 to 7.1)	3443	576	16.7 15.5 to 18.0)
200-1999	23147	2345	10.1 (9.7 to 10.5)	1465	297	20.3 (18.2 to 22.3)
1-199	2862	246	8.6 (7.6 to 9.6)	618	31	5.0 (3.3 to 6.7)

Straube et al. BMC Gastroenterology 2009 9:41 doi:10.1186/1471-230X-9-41

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Mortality With Upper Gastrointestinal Bleeding and Perforation: Effects of Time and NSAID Use

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