Variceal vs non-variceal acute upper gastrointestinal bleeding: outcomes in the 2022 UK audit

Introduction

Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. We compare the characteristics and management of variceal vs non-variceal causes of AUGIB in the 2022 UK audit.

Methods

Prospective multi-centre observational study of adults (>16 years) presenting in or to UK hospitals with AUGIB between 3 May and 2 July 2022.

Results

In this interim analysis, endoscopy was performed for 2315 of the first 2881 patients and a cause identified in 1542. Those identified with varices (14%, 212/1542) were younger than those with non-variceal AUGIB (median age 57 vs 70 yr, respectively). For varices, sites included:87%(185/212) oesophageal;18%(38/212) gastric;3%(7/212) duodenal. 43%(92/212) were on non-selective beta-blocker prophylaxis on admission;32%(68/212) had a history of previous AUGIB and 24%(50/212) were on a variceal band ligation programme. 69%(147/212) had stigmata of recent bleeding;75%(160/212) received endotherapy:62%(132/212) had variceal therapy (banding – 124, glue or thrombin injection – 11) and 6%(12/212) required a Sengstaken tube. 4%(8/212) underwent TIPSS and 58%(123/212) were discharged on a non-selective beta-blocker. For those with non-variceal causes, findings included:58%(777/1330) peptic ulcer disease;26%(353/1330) oesophagitis;5%(69/1330) portal hypertensive gastropathy;7%(96/1330) malignancy and 28%(369/1330) others. 38%(506/1330) had stigmata of recent bleeding;34%(447/1330) received endotherapy:13%(176/1330) had a single modality and 20%(271/1330) ≥1 modality. Different modalities included:23%(105/447) thermal device;60%(270/447) adrenaline injection;48%(215/447) haemostatic clips;24%(109/447) haemostatic powders or gel;14%(64/447) argon plasma coagulation and 8%(37/447) others. Outcomes for patients with variceal vs non-variceal cause of bleeding are shown (table 1).

Conclusions

Patients with variceal bleeding were younger, with higher therapeutic and transfusion requirements, re-bleeding rates and length of stay. Mortality was not significantly different to non-variceal bleeding.