Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 723-739
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.723
The global epidemiology of upper and lower gastrointestinal bleeding in general population: A systematic review
Şiir Su Saydam, Megan Molnar, Pareen Vora
Şiir Su Saydam, Megan Molnar, Pareen Vora, Integrated Evidence Generation, Bayer AG, Berlin 13353, Germany
Author contributions: Saydam SS and Vora P designed the research study; Saydam SS, Molnar M and Vora P performed the research; Saydam SS analyzed the data and wrote the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Saydam SS and Vora P are employees of Bayer AG. Molnar M was an employee of Bayer AG at the time the study was carried out.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Pareen Vora, PhD, Director, Integrated Evidence Generation, Bayer AG, Muellerstr. 178, Berlin 13353, Germany. pareen.vora@bayer.com
Received: October 19, 2022
Peer-review started: October 19, 2022
First decision: January 3, 2023
Revised: January 20, 2023
Accepted: March 8, 2023
Article in press: March 8, 2023
Published online: April 27, 2023
Abstract
BACKGROUND

Gastrointestinal bleeding (GIB) is a common and potentially life-threatening clinical event. To date, the literature on the long-term global epidemiology of GIB has not been systematically reviewed.

AIM

To systematically review the published literature on the worldwide epidemiology of upper and lower GIB.

METHODS

EMBASE® and MEDLINE were queried from 01 January 1965 to September 17, 2019 to identify population-based studies reporting incidence, mortality, or case-fatality rates of upper GIB (UGIB) or lower GIB (LGIB) in the general adult population, worldwide. Relevant outcome data were extracted and summarized (including data on rebleeding following initial occurrence of GIB when available). All included studies were assessed for risk of bias based upon reporting guidelines.

RESULTS

Of 4203 retrieved database hits, 41 studies were included, comprising a total of around 4.1 million patients with GIB worldwide from 1980–2012. Thirty-three studies reported rates for UGIB, four for LGIB, and four presented data on both. Incidence rates ranged from 15.0 to 172.0/100000 person-years for UGIB, and from 20.5 to 87.0/100000 person-years for LGIB. Thirteen studies reported on temporal trends, generally showing an overall decline in UGIB incidence over time, although a slight increase between 2003 and 2005 followed by a decline was shown in 5/13 studies. GIB-related mortality data were available from six studies for UGIB, with rates ranging from 0.9 to 9.8/100000 person-years, and from three studies for LGIB, with rates ranging from 0.8 to 3.5/100000 person-years. Case-fatality rate ranged from 0.7% to 4.8% for UGIB and 0.5% to 8.0% for LGIB. Rates of rebleeding ranged from 7.3% to 32.5% for UGIB and from 6.7% to 13.5% for LGIB. Two main areas of potential bias were the differences in the operational GIB definition used and inadequate information on how missing data were handled.

CONCLUSION

Wide variation was seen in estimates of GIB epidemiology, likely due to high heterogeneity between studies however, UGIB showed a decreasing trend over the years. Epidemiological data were more widely available for UGIB than for LGIB.

Keywords: Gastrointestinal bleeding, Gastrointestinal haemorrhage, Epidemiology, Incidence, Mortality, Case-fatality

Core Tip: This review addresses an important literature gap in summarizing the long-term global epidemiology of GIB. Epidemiological data were more widely available for UGIB than for LGIB, which were limited. Estimates of GIB were highly heterogeneous, often due to differences in case definitions, but showed a decreasing trend for UGIB incidence.