Endoscopy reduces mortality in UGIH patients

MedWire News: Mortality among patients with acute non-variceal upper gastrointestinal hemorrhage (UGIH) is reduced by endoscopy, say Italian scientists who suggest care on a gastroenterology ward may offer additional benefits.

In-hospital mortality has been suggested as a possible indicator of quality of care among patients with UGIH, and is strongly influenced by comorbidities, age, and psychosocial factors, along with traditional disease-related factors.

To determine the impact of endoscopy and care in a gastroenterology ward, Anna Kohn, from AO San Camillo Forlanini in Rome, and colleagues identified all hospitalizations with a main diagnosis of UGIH between 2000 and 2005 on the Regional Hospital Information System for the Lazio region.

In all, there were 13,427 hospitalizations for UGIH. The average age of the patients was 68 years and 60% were male. Cross-checking with data from the Regional Registry of Causes of Death, the team found that the 30-day mortality rate was 6.9%. Endoscopy was reported for 74.2% of patients, while specialist care was employed for just 6.4% of patients.

Logistic regression analysis revealed that hospitalizations that included endoscopy, specialist care, or both, were associated with significantly lower mortality rates, at odds ratios of 0.30, 0.55, and 0.12, respectively, compared with hospitalizations without these factors. These associations remained even after controlling for potential risk factors, the team reports in the journal Digestive and Liver Diseases.

They write: "In conclusion, our findings confirm that endoscopy, per se, reduces mortality among patients hospitalized for UGIH and that this protective effect is enhanced if the patient is also cared for in a gastroenterology ward.

"The administrative data we analyzed indicate that, in the Lazio region of Italy, endoscopy is being under-used during hospitalizations for UGIH."

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