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

Table 1 Basic information for studies

Ref.	Study period	Country (region)	Data source1	Design	Clinical event
Schlup et al[24], 1984	1 September 1980 - 28 February 1982	New Zealand (Dunedin)	Clinical data (Dunedin public hospitals)	P	UGIB
Katschinski et al[25], 1989	1 April 1984 - 31 March 1986	UK (Nottingham)	Clinical data (The Nottingham City and University Hospitals)	P	UGIB
Longstreth[26], 1995	1991	USA (San Diego)	Administrative claims database (KPMCP)	R	AUGIB
Bramley et al[27], 1996	October 1991 - September 1993	Scotland (Grampian and the Northern Isles)	Clinical data (Aberdeen Royal Infirmary)	P	LGIB
Masson et al[28], 1996	October 1991 - September 1993	Scotland (Orkney and Shetland)	Clinical data (Aberdeen Royal Infirmary)	P	UGIB
Blatchford et al[60], 1997	September 1992 - Feb 1993	West Scotland	Clinical data (Multicenter)	P	AUGIB
El Bagir et al[29], 1997	May 1991 - May 1993	Saudi Arabia (Abha City)	Clinical data (Asir Central Hospital)	P	AUGIB
Longstreth[30], 1997	January 1990 - December 1993	USA (San Diego)	Claims (KPMCP)	R	ALGIB
Soplepmann et al[61], 1997	1 August 1992 - 31 July 1994	Finland (Central Finland)	Clinical data (Central Hospital of Central Finland)	P	AUGIB
		Estonia (Tartu)	Clinical data (Tartu University Hospital)
Vreeburg et al[31], 1997	July 1993 - July 1994	Netherlands (Amsterdam area)	Hospital survey (Two university and ten regional hospitals)	P	AUGIB
Czernichow et al[32], 2000	1 January - 30 June 1996	France (Finistere, Gironde, Seine Maritime and Somme)	Hospital survey (29 public hospitals and 96 private practices)	P	AUGIB
Paspatis et al[33], 2000	February 1998 - February 1999	Greece (Heraklion, Crete)	Hospital survey	P	AUGIB
Tenias Burillo et al[34], 2001	April 1995 - March 1999	Spain (Valencia)	Clinical data (Lluis Alcanyis Hospital)	P	NVUGIB
Lewis et al[62], 2002	1992 - 1999	USA	Hospital survey (NHDS)	R	UGIB
van Leerdam et al[63], 2003	January 2000 - January 2001	Netherlands (Amsterdam area)	Hospital survey (Two university and ten regional hospitals)	P	AUGIB
Targownik et al[35], 2006	1993 - 2003	Canada	Administrative database (HPOID)	R	AUGIB
Theocharis et al[36], 2008	January 1995- December 1995	Greece (Achaia)	Clinical data (Three regional hospitals)	R	AUGIB
	January - December 2005			P
Kapsoritakis et al[37], 2009	1 December 2005 - 30 November 2006	Greece (Thessaly, Larissa)	Clinical data (University Hospital of Larissa)	P	AUGIB
Lanas et al[38], 2009	1 January 1996 - 30 December 2005	Spain	Administrative database (10 hospitals of Spanish NHS)	R	NVUGIB
					LGIB
Loperfido et al[39], 2009	1 October 1983 - 31 December 1985	Italy (Treviso)	Clinical data (Treviso Hospital)	P	AUGIB
	1 January 2002 - 31 March 2004
Åhsberg et al[40], 2010	1 January - 31 December 1984	Sweden (Skåne)	Clinical data (Lund University Hospital)	R	NVUGIB
					LGIB
	1 January - 31 December 1994				NVUGIB
					LGIB
	1 January - 31 December 2004				NVUGIB
					LGIB
Button et al[41], 2011	1 April 1999 - 31 March 2007	Wales	Linked administrative database (PEDW)	R	UGIB
Langner et al[42], 2011	2000 – 2005	Germany	Administrative database (GHS)	R	UGIB
Crooks et al[43], 2012	1 April 1997 - 30 August 2010	England	Linked EHR data (GPRD and HES)	R	UGIB
Laine et al[44], 2012	2001 - 2009	USA	Administrative claims database (Premier Perspective)	R	UGIB
					LGIB
Miyamoto et al[45], 2012	1997 - 2008	Japan (Aki-Ota, Hiroshima)	Clinical data	R	UGIB
Mungan et al[46], 2012	6 January - 10 March 2009	Turkey	Cohort study (ENERGIB survey)	R	NVUGIB
Nahon et al[47], 2012	March 2005 - February 2006	France	Hospital survey (53 hospitals)	P	UGIB
Sangchan et al[48], 2012	1 October 2009 - 30 September 2010	Thailand	Claims and clinical data	R	UGIB
Del Piano et al[49], 2013	June 2006 - June 2007 and December 2008 - December 2009	Italy	Clinical data (13 hospitals)	P	ANVUGIB
Hreinsson et al[50], 2013a	1 January 2010 - 31 December 2010	Iceland (Reykjavik)	Clinical data (National University Hospital of Iceland)	P	ALGIB
Hreinsson et al[51], 2013b	1 January 2009 - 31 December 2010	Iceland (Reykjavik)	Clinical data (National University Hospital of Iceland)	P	AUGIB
Cavallaro et al[45], 2014	January 2001 - December 2010	Italy (Veneto)	Administrative database (HDRs)	R	UGIB
					LGIB
Marmo et al[53], 2014	March 2003 - March 2004 and April 2007 - May 2008	Italy	Administrative database (PNED1 and PNED2)	P	NVUGIB
O'Byrne et al[54], 2014	1 January 2008 - 31 December 2009	Canada (Saskat-chewan)	Clinical data (SHR and RQHR)	R	NVUGIB
Abougergi et al[64], 2015	1989 - 2009	USA	Administrative database (NIS)	R	UGIB
Niikura et al[55], 2015	1 July 2010 - 31 March 2012	Japan	Administrative claims database (DPC)	R	LGIB
Taha et al[56], 2015	2007 - 2012	Scotland (Ayrshire)	Clinical data (University Hospital Crosshouse)	R	UGIB
Lu et al[57], 2018	1 January 2008 - 31 December 2012	China	Hospital survey (Eight hospitals)	R	NVUGIB
Park et al[58], 2018	February 2011 - December 2013	South Korea (Daegu, Gyeong-sang)	Clinical data (Eight hospitals)	P	UGIB
Wuerth et al[59], 2018	2002 - 2012	USA	Administrative database (NIS)	R	UGIB

¹Clinical data: Hospital records; Hospital survey: Survey or standardized questionnaire being administered to multiple hospitals or healthcare practices to gather clinical records; Administrative database: Inpatient data collected by government or research organizations. Linkage refers to combining information from multiple data sources of the same population, removing duplicates.

EHR: Electronic health records; EMR: Electronic medical records; KPMCP: Kaiser Permanente Medical Care Program; HDRs: Health Discharge Records; HPOID: Health Person-Oriented Information Database; NHS: National Health Services; PEDW: Patient Episode Database for Wales; ENERGIB: European Survey of Non-Variceal Upper Gastro Intestinal Bleeding; GHS: German Hospital Statistics; GPRD: General Practice Research Database; HES: Hospital Episodes Statistics; PNED: Progetto Nazionale Emorragie Digestive; SHR: Saskatoon Health Region; RQHR: Regina Qu’Appelle Health Region; NIS: Healthcare Cost and Utilization Project Nationwide Inpatient Sample; DPC: Diagnosis Procedure Combination; P: Prospective; R: Retrospective; ALGIB: Acute lower gastrointestinal bleeding; AUGIB: Acute gastrointestinal bleeding; ANVUGIB: Acute nonvariceal upper gastrointestinal bleeding; LGIB: Lower gastrointestinal bleeding; NVUGIB: Nonvariceal upper gastrointestinal bleeding; UGIB: Upper gastrointestinal bleeding.

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.