Trends in acute non-variceal bleeding in Israel in 1996–2007: A significant decrease in the rates of bleeding peptic ulcers

Abstract 

Background

A decrease in the incidence of hospital admissions for acute non-variceal upper GI bleeding (AUGIB) has been reported in regions with a low prevalence of Helicobacter pylori (HP) infection.

Aim

To investigate trends in hospital admissions for AUGIB in Israel, where the prevalence of HP infection is intermediate.

Methods

We have searched the National Hospital Discharge Database of the Israeli Ministry of Health, where all admissions to acute care hospitals for the period January 1, 1996 through December 31, 2007 are compiled. Using a validated strategy, we identified all admissions for AUGIB according to ICD-9-CM codes. Incidence rates were calculated and adjusted to reflect the age and gender distribution of the Israeli population.

Results

The overall rates of hospital admissions for AUGIB decreased significantly from 29.3 to 16.8cases/10⁵population/year (p<0.0001). The decreases were similar in both genders. This decrease was due to decreased rates of bleeding from duodenal ulcers (from 13.6 to 5cases/10⁵population/year) and gastric ulcers (from 4.3 to 2.4cases/10⁵population/year). The rates of bleeding from other causes remained unchanged. The rates of surgical interventions bleeding control decreased significantly (overall from 11 to 4%). The in-hospital mortality rate varied between 7.6 and 7%, did not change significantly in both genders but increased significantly with age during the study period.

Conclusions

A decline in the overall incidence of AUGIB during the study period was due to a significant decrease in the rate of bleeding peptic ulcers.

Keywords: Acute non-variceal upper GI bleeding, Bleeding peptic ulcers, Hospital admissions, Incidence, In-hospital mortality rate