The global epidemiology of upper and lower gastrointestinal bleeding in general population: A systematic review

Table 2 Study characteristics, n (%)

Ref.	Diagnostic criteria	Total patients, (male)	Age1, (mean)	Population at risk	Re-bleeding	Diagnostic endoscopy2	In-hospital bleeds3
Schlup et al[24], 1984	Hematemesis and/or melena	112 (58.0)	≥ 15 (61.5)	120000 - 150000	18 (16.1)	Yes	Unclear
Katschinski et al[25], 1989	Hematemesis and/or melena	1017 (N/A)	All (N/A6)	789000	N/A	Yes	Unclear
Longstreth[26], 1995	ICD-9-CM	258 (63.6)	≥ 20 (60.6)	270699	N/A	Yes	Yes
Bramley et al[27], 1996	Suspected UGIB or LGIB	252 (46.8)	All (N/A6)	467760	34 (13.5)	Some	Yes
Masson et al[28], 1996	Suspected UGIB or LGIB	1098 (62.2)	All (N/A6)	468000	N/A	Yes	Yes
Blatchford et al[60], 1997	Hematemesis and/or melena; using standard definitions	1882 (64.2)	≥ 15 (N/A6)	2184285	N/A	Some	Yes
El Bagir et al[29], 1997	Hematemesis and/or melena	240 (62.5)	≥ 20 (44.3)	450000	N/A	Yes	Unclear
Longstreth[30], 1997	ICD-9-CM	219 (55.7)	≥ 20 (67.2)	N/A	14 (6.7)	Yes	Yes
Soplepmann et al[61], 1997	Hematemesis and/or melena	270 (66.7)	≥ 15 (64.2)	257000	N/A	Yes	Yes
		243 (60.0)	≥ 15 (58.8)	159000	N/A
Vreeburg et al[31], 1997	Hematemesis, melena, hematochezia, or blood admixture upon nasogastric aspiration	951 (60.0)	All (Mdn: 71)	1610900	156 (16.4)	Yes	Yes
Czernichow et al[32], 2000	Hematemesis and/or melena	2133 (63)	≥ 18 (Mdn: 68)	2926241	N/A	Yes	Yes
Paspatis et al[33], 2000	Hematemesis, melena or other clinical or laboratory evidence of blood loss from the upper GI tract	353 (63.5)	≥ 16 (66.2)	220000	41 (12)	Yes	Yes
Tenias Burillo et al[34], 2001	All admitted patients with UGIB	779 (62.1)	Adults (63.4)	180996	N/A	Yes	Unclear
Lewis et al[62], 2002	ICD-9-CM	N/A	All (N/A)	N/A	N/A	Unclear	Yes
van Leerdam et al[63], 2003	Hematemesis, melena, hematochezia, or blood admixture upon nasogastric aspiration	769 (56.0)	All (N/A6)	1612439	119 (16.0)	Yes	Yes
Targownik et al[35], 2006	ICD-9 and ICD-10-CA	1423634 (N/A)	≥18 (62.0-66.0)	21944828-24324251	N/A	Unclear	No
Theocharis et al[36], 2008	Hematemesis, bloody nasogastric aspiration, or melena and clinical/laboratory evidence of acute blood loss from the upper GI tract	489 (74.4)	> 16 (59.4)	300078	48 (9.9)	Yes	Yes
		353 (72.5)	> 16 (66.1)	326794	26 (7.3)
Kapsoritakis et al[37], 2009	All patients hospitalized for acute UGIB	264 (75.4)	≥ 16 (65.5)	228428	21 (7.9)	Yes	Yes
Lanas et al[38], 2009	ICD-9-CM	176634 (N/A)	All (N/A6)	3281973 - 3681822	N/A	Unclear	No
		57694 (N/A)
Loperfido et al[39], 2009	ICD-9	532 (72.3)	> 15 (61.0)	231914	191 (32.5)	Yes	Yes
		513 (64.3)	> 15 (68.7)	266791	40 (7.4)
Åhsberg et al[40], 2010	ICD-8	138 (75.0)	Adults (Mdn: 69)	151711	N/A	Yes	Unclear
		69 (46.0)	Adults (Mdn: 69)
	ICD-9	123 (60.0)	Adults (Mdn: 73)	170727
		95 (45.0)	Adults (Mdn: 76)
	ICD-10	181 (59.0)	Adults (Mdn: 77)	289560
		125 (54.0)	Adults (Mdn: 75)
Button et al[41], 2011	ICD-10	222995 (54.4)	≥ 18 (64.1)	N/A	N/A	Some	Yes
Langner et al[42], 2011	ICD-9-GM	942325 (51.4)	All (N/A6)	N/A	N/A	Unclear	No
Crooks et al[43], 2012	ICD-10 (HES) and Read code system (GPRD)	347085	≥ 18 (N/A6)	N/A	N/A	Unclear	Unclear
Laine et al[44], 2012	ICD-9	N/A	All (N/A)	N/A	N/A	Unclear	No
Miyamoto et al[45], 2012	Hematemesis and/or melena	2367 (53.7)	All (67.9)	Approximately 16065	N/A	Yes	Unclear
Mungan et al[46], 2012	ICD-9/ICD-10	423 (67.4)	Adults (57.8)	N/A	28 (6.6)	Yes	Yes
Nahon et al[47], 2012	Hematemesis and/or melena and/or acute anemia with blood in the stomach	3203 (66.5)	≥ 18 (Mdn: 64.1)	N/A	317 (9.9)	Yes	No
Sangchan et al[48], 2012	ICD-10	771115 (69.2)	Adults (58.5)	N/A	N/A	Some	No
Del Piano et al[49], 2013	Presenting to the emergency room for NVUGIB	1413 (66.0)	All (53.2)	N/A	77 (5.4)	Yes	No
Hreinsson et al[50], 2013a	(1) Passage of bright red blood per rectum or maroon colored without hematemesis and (2) Melena with no bleeding in upper GI endoscopy	131 (49.7)	≥ 18 (Mdn: 68)	151008	N/A	Yes	Yes
Hreinsson et al[51], 2013b	(1) Hematemesis or coffee ground vomit; (2) Melena; and (3) Rectal bleeding with confirmed bleeding on upper gastroendoscopy and negative colonoscopy	132 (58.0)	18-105 (Mdn: 71)	N/A	N/A	Yes	Yes
Cavallaro et al[45], 2014	ICD-9-CM	23450 (59.5)	All (64.2)	4912438	N/A	Unclear	No
		13800 (47.8)
Marmo et al[53], 2014	Hematemesis, melena or dark, tarry materials on rectal examination	2317 (65.9)	≥ 18 (67.9)	N/A	86 (3.7)	Yes	Yes
O'Byrne et al[54], 2014	ICD-10	360 (61.7)	17-100 (66.5)	1200000	73 (20.3)	Yes	Yes
Abougergi et al[64], 2015	ICD-9-CM	12664264 (54.5)	All (Mdn: 67.0-70.0)	N/A	N/A	Yes	No
Niikura et al[55], 2015	ICD-10	30846 (52.0)	≥ 20 (Mdn: 74)	N/A	N/A	Unclear	No
Taha et al[56], 2015	ICD-10	8694 (62.5)	All (Mdn: 63)	258370 -260280	N/A	Unclear	Unclear
Lu et al[57], 2018	(1) Hematemesis and/or melena; (2) Drainage of coffee grounds or fresh blood in the gastric tube; (3) Positive FOBT; and (4) Varices, but endoscopy confirmed that bleeding was unrelated	2977 (76.5)	≥ 18 (54.7)	N/A	87 (2.9)	Yes	Yes
Park et al[58], 2018	Hematemesis, melena, and hematochezia or a suspicious clinical presentation of UGIB such as syncope, epigastric pain, dyspnea, dizziness, altered mental status, or anemia	1424 (74.1)	≥ 16 (62.7)	N/A	110 (7.7)	Yes	No
Wuerth et al[59], 2018	ICD-9-CM	2432088 (55.0)	≥ 18 (N/A6)	N/A	N/A	Some	No

¹Age category of patients included in the study, given in years. If not defined in the methods, the age range of included participants is stated. Median age is noted, when mean age is not available. Mdn: median.

²Endoscopy, colonoscopy, sigmoidoscopy or any other diagnostic screening methods being used to identify or validate the diagnosis of patients as a standard procedure.

³Including bleeding events that occurred while the patient is being hospitalized for another disease. In administrative databases, if patients only have a primary diagnosis of GIB, in-hospital bleeds are assumed to not be included.

⁴Total number of patients across the entire study period is provided. Stratified data for each year is available in full text.

⁵The value reflects the number of hospitalizations, not the number of patients.

⁶Distribution of the number of patients is available for each age group.

ICD: International Classification of Diseases (ICD-8: ICD, Eight Revision; ICD-9: ICD, Ninth Revision; ICD-10: ICD, Tenth Revision; ICD-9-CM: ICD-9, Clinical Modification; ICD-9-CA: ICD-9, Canadian Adaptation; ICD-9-GM: ICD-9, German Modification); FOBT: Fecal occult blood test; GI: Gastrointestinal; ANVUGIB: Acute nonvariceal upper gastrointestinal bleeding; LGIB: Lower gastrointestinal bleeding; NVUGIB: Nonvariceal upper gastrointestinal bleeding; UGIB: Upper gastrointestinal bleeding.