LGIB surpassed UGIB as leading source of GI bleeding in HK

Lower gastrointestinal bleeding (LGIB) has surpassed upper gastrointestinal bleeding (UGIB) as the leading source of gastrointestinal bleeding (GIB) in Hong Kong, especially among the elderly, data from patients hospitalized for GIB in all local public hospitals in 2009–2019 have shown.

The study, conducted by researchers from the University of Hong Kong, included 169,699 GIB hospitalization events (nonvariceal UGIB: n=56,884; 33.5 percent) (LGIB: n=74,230; 43.7 percent) during the 10-year study period. LGIB was found to have surpassed UGIB in incidence from 2011 onwards, becoming the leading source of GIB in Hong Kong, with the ratio of UGIB to LGIB decreasing from 1.43 in January 2009 to 0.43 in December 2019. [United European Gastroenterol J 2021;doi:10.1002/ueg2.12067]

The monthly incidence of LGIB fluctuated at around 8.51 per 100,000 person-months and showed a slight decreasing trend (p<0.001) during the study period. However, an increasing trend was observed in those ≥80 years of age, in both male and female. No significant difference in LGIB incidence was observed between the genders (p=0.487).

The monthly incidence of UGIB showed a progressively declining trend, from 10.42 per 100,000 person-months in January 2009 to 3.26 per 100,000 person-months in December 2019 (p<0.001). The incidence increased with age and was the highest in those aged ≥80 years. While men had more UGIB than women (p<0.001), a decreasing incidence was observed in both genders and the decrease was more obvious in those ≥60 years of age.

The researchers also evaluated effects of population prescriptions of aspirin, NSAIDs, proton-pump inhibitors (PPIs), anticoagulants, other antiplatelet drugs, and Helicobacter pylori eradication therapies on trends of GIB. The analysis included prescriptions of oral aspirin, NSAIDs, PPIs, anticoagulants and other antiplatelet drugs, given between January 2009 and December 2018 on an outpatient basis at all hospitals and clinics of the Hospital Authority, as well as the number of patients who had received their first course of clarithromycin-containing triple therapy for H. pylori eradication.

The rising trend of aspirin prescription was found to be associated with increases in the incidence of both UGIB (coefficient, 0.06; 95 percent confidence interval [CI], 0.04 to 0.07; p<0.001) and LGIB (coefficient, 0.04; 95 percent CI, -0.05 to 0.03; p<0.001).

In contrast, increasing PPI prescriptions were associated with a decrease in incidence of UGIB (coefficient, -4.58; 95 percent CI, -5.69 to -3.47; p<0.001), but no significant association was found between PPI prescriptions and LGIB incidence (coefficient, -1.01; 95 percent CI, -2.26 to 0.24).

No significant associations were found between prescriptions of NSAIDs, anticoagulants or other antiplatelet drugs and the incidence of either UGIB or LGIB. Likewise, the number of patients who had received H. pylori eradication therapies was not significantly associated with the trend of UGIB.

“Based on predicted population prescriptions of aspirin and PPIs, [the incidence of] UGIB is predicted to continue to decline in the subsequent 3 years, but [that of] LGIB is predicted to increase, particularly with the increasing use of aspirin,” the researchers wrote.

“An additional 20 percent increase in PPI prescriptions would be associated with a further decrease in the incidence of UGIB, whereas a 20 percent increase in aspirin prescription would increase the incidence,” they noted.