Hospital-acquired gastrointestinal bleeding outside the critical care unit

risk factors, role of acid suppression, and endoscopy findings.

Mohammed A. Qadeer, Joel E. Richter, Daniel Brotman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Risk factors for hospital-acquired gastrointestinal bleeding in the intensive care unit are established, and acid-suppressive prophylaxis has been advocated for certain subsets of critically ill patients. In contrast, risk factors and appropriate prevention strategies are not yet established for general medical patients. The objective of this study was to identify risk factors for nosocomial gastrointestinal bleeding (GIB) in non-critically ill medical patients, to evaluate the utility of prophylactic gastric acid suppression, and to characterize the endoscopic lesions. METHODS: This was a retrospective case-control study that took place at a U.S. tertiary care center. All patients admitted to the General Medicine ward for nongastrointestinal disorders who developed clinically relevant gastrointestinal bleeding during admission or within 4 weeks of discharge were considered cases. Clinically relevant bleeding was defined as any bleeding requiring esophagogastroduodenoscopy (EGD). Random controls were matched to cases by date of hospitalization in a 1:1 ratio. Clinical information was extracted by chart review. RESULTS: Of 17,707 patients admitted to the General Medicine ward over a 4-year period, 73 (0.41%) met the case definition. The main risk factor for nosocomial GIB was treatment with full dose anticoagulants or clopidogrel (OR = 5.4; 2.6-11.7; P <.0001). Use of aspirin, nonsteroidal anti-inflammatory medications, and glucocorticoids did not differ significantly between cases and controls. De novo acid-suppressive prophylaxis was not protective (OR = 1.0; 95% CI: 0.4-2.4; P = 0.97). Endoscopic abnormalities were noted in 74% of patients; many cases had lesions unlikely to be prevented by acid blockade. CONCLUSIONS: Hospital-acquired gastrointestinal bleeding is uncommon in non-critically ill patients. Anticoagulation appears to be the most important risk factor for nosocomial GIB. Routine use of acid suppressant medications for prophylaxis is unnecessary in most hospitalized patients. (c) 2006 Society of Hospital Medicine.

Original languageEnglish (US)
Pages (from-to)13-20
Number of pages8
JournalJournal of Hospital Medicine
Volume1
Issue number1
DOIs
StatePublished - Jan 2006
Externally publishedYes

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Critical Care
Endoscopy
Hemorrhage
Acids
Patients' Rooms
clopidogrel
Medicine
Digestive System Endoscopy
Gastric Acid
Tertiary Care Centers
Critical Illness
Anticoagulants
Glucocorticoids
Aspirin
Intensive Care Units
Case-Control Studies
Hospitalization
Anti-Inflammatory Agents

ASJC Scopus subject areas

  • Medicine(all)

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Hospital-acquired gastrointestinal bleeding outside the critical care unit : risk factors, role of acid suppression, and endoscopy findings. / Qadeer, Mohammed A.; Richter, Joel E.; Brotman, Daniel.

In: Journal of Hospital Medicine, Vol. 1, No. 1, 01.2006, p. 13-20.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Risk factors for hospital-acquired gastrointestinal bleeding in the intensive care unit are established, and acid-suppressive prophylaxis has been advocated for certain subsets of critically ill patients. In contrast, risk factors and appropriate prevention strategies are not yet established for general medical patients. The objective of this study was to identify risk factors for nosocomial gastrointestinal bleeding (GIB) in non-critically ill medical patients, to evaluate the utility of prophylactic gastric acid suppression, and to characterize the endoscopic lesions. METHODS: This was a retrospective case-control study that took place at a U.S. tertiary care center. All patients admitted to the General Medicine ward for nongastrointestinal disorders who developed clinically relevant gastrointestinal bleeding during admission or within 4 weeks of discharge were considered cases. Clinically relevant bleeding was defined as any bleeding requiring esophagogastroduodenoscopy (EGD). Random controls were matched to cases by date of hospitalization in a 1:1 ratio. Clinical information was extracted by chart review. RESULTS: Of 17,707 patients admitted to the General Medicine ward over a 4-year period, 73 (0.41{\%}) met the case definition. The main risk factor for nosocomial GIB was treatment with full dose anticoagulants or clopidogrel (OR = 5.4; 2.6-11.7; P <.0001). Use of aspirin, nonsteroidal anti-inflammatory medications, and glucocorticoids did not differ significantly between cases and controls. De novo acid-suppressive prophylaxis was not protective (OR = 1.0; 95{\%} CI: 0.4-2.4; P = 0.97). Endoscopic abnormalities were noted in 74{\%} of patients; many cases had lesions unlikely to be prevented by acid blockade. CONCLUSIONS: Hospital-acquired gastrointestinal bleeding is uncommon in non-critically ill patients. Anticoagulation appears to be the most important risk factor for nosocomial GIB. Routine use of acid suppressant medications for prophylaxis is unnecessary in most hospitalized patients. (c) 2006 Society of Hospital Medicine.",
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AB - BACKGROUND: Risk factors for hospital-acquired gastrointestinal bleeding in the intensive care unit are established, and acid-suppressive prophylaxis has been advocated for certain subsets of critically ill patients. In contrast, risk factors and appropriate prevention strategies are not yet established for general medical patients. The objective of this study was to identify risk factors for nosocomial gastrointestinal bleeding (GIB) in non-critically ill medical patients, to evaluate the utility of prophylactic gastric acid suppression, and to characterize the endoscopic lesions. METHODS: This was a retrospective case-control study that took place at a U.S. tertiary care center. All patients admitted to the General Medicine ward for nongastrointestinal disorders who developed clinically relevant gastrointestinal bleeding during admission or within 4 weeks of discharge were considered cases. Clinically relevant bleeding was defined as any bleeding requiring esophagogastroduodenoscopy (EGD). Random controls were matched to cases by date of hospitalization in a 1:1 ratio. Clinical information was extracted by chart review. RESULTS: Of 17,707 patients admitted to the General Medicine ward over a 4-year period, 73 (0.41%) met the case definition. The main risk factor for nosocomial GIB was treatment with full dose anticoagulants or clopidogrel (OR = 5.4; 2.6-11.7; P <.0001). Use of aspirin, nonsteroidal anti-inflammatory medications, and glucocorticoids did not differ significantly between cases and controls. De novo acid-suppressive prophylaxis was not protective (OR = 1.0; 95% CI: 0.4-2.4; P = 0.97). Endoscopic abnormalities were noted in 74% of patients; many cases had lesions unlikely to be prevented by acid blockade. CONCLUSIONS: Hospital-acquired gastrointestinal bleeding is uncommon in non-critically ill patients. Anticoagulation appears to be the most important risk factor for nosocomial GIB. Routine use of acid suppressant medications for prophylaxis is unnecessary in most hospitalized patients. (c) 2006 Society of Hospital Medicine.

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