Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

Abstract

BACKGROUND

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate.

AIM

To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.

METHODS

We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023, utilizing our medical record system. Data pertaining to general patient information, etiological factors, disease outcomes, and other relevant variables were meticulously collected and analyzed.

RESULTS

Among the 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, with a higher prevalence among males. Notably, 43.6% of patients presented with black stool as their primary complaint, while 27.4% had hematemesis as their initial symptom. Upon admission, 17% of patients exhibited both hematemesis and black stool, while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent routine blood examinations at admission revealed that 75.8% of patients had anemia, with 63.4% experiencing moderate to severe anemia, and 1.5% having extremely severe anemia (hemoglobin < 30 g/L). With regard to etiology, 53.2% of patients experienced bleeding without a definitive trigger, 24.2% had a history of using gastric mucosa-irritating medications, 24.2% developed bleeding after alcohol consumption, 2.8% attributed it to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue preceding the bleeding episode. Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals, while bleeding due to alcohol consumption showed the opposite trend. Additionally, diet-related bleeding was more common among the young age group compared to the middle-aged group. Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB (73.3%), followed by gastrointestinal malignancies (10.9%), acute gastric mucous lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%) among inpatients with ANVUGIB. Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, resulting in an endoscopic treatment rate of 12.8%, with a high immediate hemostasis success rate of 94.1%.

CONCLUSION

ANVUGIB patients exhibit diverse characteristics across different age groups, and endoscopic hemostatic treatments have demonstrated remarkable efficacy.

Key Words: Acute non-varicose upper gastrointestinal bleeding; Clinical characteristics; Cause of disease; Endoscopic homeostatic therapy

Core Tip: This retrospective study analyzed the data of patients diagnosed with acute non-varicose upper gastrointestinal bleeding (ANVUGIB) through endoscopic examinations at our hospital. The results revealed distinct characteristics among patients of different age groups with ANVUGIB. Although this study was conducted at a single center, the age and gender distribution of the patients in this study were similar to those reported in previous multicenter studies in China. The study also assessed the therapeutic effectiveness of endoscopic hemostatic treatment, and indicated that it is an effective approach for treating ANVUGIB, improving efficacy, and deserves wider application.

INTRODUCTION

Non-variceal upper gastrointestinal bleeding (NVUGIB) is characterized as gastrointestinal hemorrhage that originates proximal to the ligament of Treitz in the duodenum. Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) represents a common emergency in the field of Gastroenterology, accounting for 80%-90% of all cases of gastrointestinal bleeding[1]. It is characterized by its sudden onset, rapid progression, and high mortality rate[2]. The primary cause of NVUGIB is typically gastroduodenal peptic ulcers, succeeded by gastroduodenal erosions. Other prevalent causes include peptic esophageal lesions (esophagitis or esophageal ulcers), vascular anomalies such as Dieulafoy lesions (a medical condition characterized by an abnormal, tortuous arteriole penetrating the gastrointestinal mucosa), and vascular ectasias such as angiodysplasia (a minor vascular malformation in the gut). Additionally, Mallory–Weiss tears (mucosal lacerations at the gastroesophageal junction, often associated with recurrent vomiting, particularly following excessive alcohol consumption or a large meal) and, to a lesser extent, neoplastic lesions, are also notable causes of NVUGIB[3,4]. Significant advancements in medicine over the past two decades have influenced both the incidence and outcomes of NVUGIB. On the one hand, the introduction of potent acid-suppressing medications, recognition of Helicobacter pylori as a key etiological factor in peptic ulcers leading to targeted eradication therapy, advancements in diagnostic and therapeutic endoscopy, implementation of restrictive blood transfusion policies, and enhanced management of critically ill patients are pivotal factors that have decreased the risk of developing NVUGIB and improved its management and outcomes. On the other hand, certain risk factors are becoming increasingly prevalent. These include an aging population, which contributes to a higher prevalence of cardiovascular diseases and other comorbidities that escalate the mortality risk associated with NVUGIB, and the growing use of low-dose aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and other antiplatelet and anticoagulant agents[5-7]. The etiological landscape seems to be changing over time, but the overall incidence of hospitalizations remains high. During the initial stages of this condition, patients frequently present symptoms such as hematemesis and melena, and in severe cases, peripheral circulatory failure may develop. In clinical practice, traditional medical treatments are often employed to manage ANVUGIB, but their effectiveness in controlling acute active bleeding is frequently unsatisfactory. The advent of endoscopic techniques and innovative endoscopic accessories has significantly enhanced the efficiency of hemostasis[8-10].

This study entails a retrospective analysis involving the retrieval of medical records pertaining to 532 patients who received a diagnosis of ANVUGIB through endoscopic examination at our hospital between March 2021 and March 2023. Data encompassing general patient information, etiological factors, and disease outcomes were systematically collected to gain insights into the clinical characteristics of ANVUGIB within our hospital. Furthermore, the study aims to enhance the understanding of ANVUGIB among our clinical practitioners and improve the standards of diagnosis and treatment. Additionally, the research assesses the efficacy of endoscopic hemostasis in patients who underwent this procedure.

MATERIALS AND METHODS

Patient data

The data of 532 patients diagnosed with ANVUGIB through endoscopic examinations at our hospital between March 2021 and March 2023 were retrieved from the hospital's medical records system. General patient information, etiological factors, and disease outcomes were meticulously gathered and refined. Data from patients who underwent endoscopic hemostasis treatment were specifically chosen to evaluate the effectiveness of this therapeutic approach.

Research methods

A retrospective analysis of patient data was undertaken, including age, gender, chief complaint upon admission, hemoglobin (Hb) levels, precipitating factors, etiology, treatment outcomes, and the effectiveness of endoscopic treatment. Moreover, an additional analysis examined the interplay between precipitating factors, etiology, and age groups by categorizing patients into the following groups: the young group (age < 40 years), middle-aged group (age < 60 but ≥ 40 years), and elderly group (age ≥ 60 years).

Statistical analysis

In this study, initial data collection was accomplished through Excel spreadsheets. All data underwent statistical analysis using SPSS 26.0 software. Frequency and percentage (%) were used to present count data, while measurement data were presented as means with standard deviations (mean ± SD). The comparison of count data was performed using the Pearson chi-square test or the continuity correction test, with statistical significance set at P < 0.05 to indicate significant differences.

RESULTS

General situation

A total of 532 patients diagnosed with ANVUGIB were treated at our center between March 2021 and March 2023, presenting with symptoms such as hematemesis, melena, and other upper gastrointestinal bleeding (Table 1). Among them, there were 396 males (74.44%) and 136 females (25.56%), resulting in a male-to-female ratio of 2.91:1. The age of the patients ranged from 18 to 94 years, with an average age of 53.34 ± 18.92 years and an average hospital stay of 7.6 ± 4.56 d.

Table 1 Clinical characteristics of the included patients.

Items		Number	Percentage
Sex	Men	396	74.44
	Women	136	25.56
Age (yr)	Young group (age < 40)	139	26.13
	Middle-aged group (age < 60 but ≥ 40)	221	41.54
	Elderly group (age ≥ 60)	172	32.33
Chief complaint	Melena	232	43.60
	Hematemesis	146	27.40
	Both hematemesis and melena	90	17.00
	Abdominal pain	32	6.00
	Atypical complaints (dizziness, weakness)	32	6.00
Hemoglobin levels	Hb ≤ 30 g/L	8	1.50
	Hb 30-60 g/L	58	10.90
	Hb 60-90 g/L	203	38.20
	Hb 90-120 g/L	134	25.20
	Hb ≥ 120 g/L	129	24.20
Precipitating factor	Drugs	129	24.20
	Alcohol	84	15.80
	Diet	15	2.80
	Psychological factors	21	4.00
	No precipitating factor	283	53.20

Chief complaint and hemoglobin levels on admission

After collecting and analyzing the chief complaints of patients upon admission, it was observed that the majority of ANVUGIB patients presented with a primary complaint related to gastrointestinal bleeding. Among these patients, 232 cases (43.6%) reported melena as their primary complaint, representing the highest proportion. Additionally, 146 cases (27.4%) cited hematemesis as their primary complaint, while 90 cases (17.0%) reported both hematemesis and melena. Abdominal pain was the primary complaint in 32 cases (6.0%), while 32 cases (6.0%) had atypical complaints such as dizziness and weakness, with ANVUGIB confirmed after further examination.

Urgent routine blood tests conducted upon admission revealed that 75.8% of the patients were anemic. Among them, 8 cases (1.5%) had severe anemia (Hb ≤ 30 g/L), 58 cases (10.9%) had moderate anemia (Hb 30-60 g/L), 203 cases (38.2%) had mild to moderate anemia (Hb 60-90 g/L), 134 cases (25.2%) had mild anemia (Hb 90-120 g/L), and 129 cases (24.2%) did not exhibit anemia (Hb ≥ 120 g/L).

Precipitating factor of ANVUGIB

Upon reviewing the admission records and the medical course, it was observed that 53.2% of the patients did not have an evident precipitating factor before experiencing bleeding, while nearly half of the patients had relatively clear triggers preceding the bleeding episode. Among this group, 129 cases (24.2%) had used aspirin, NSAIDs, glucocorticoids, chemotherapy, and molecular targeted drugs known to stimulate and damage the gastric mucosa. Additionally, some patients were taking anticoagulant drugs such as warfarin and rivaroxaban, which impacted their coagulation function. Eighty-four (15.8%) patients had a history of alcohol consumption before bleeding occurred. Improper diet was a contributing factor in 15 cases (2.8%), emotional excitement was noted in 9 cases (1.7%), and physical exertion was a factor in 12 cases (2.3%). Given the relatively low frequency of physical exertion and emotional excitement as precipitating factors, these will be collectively referred to as psychological factors in the subsequent text.

Relationship between etiology of ANVUGIB and age groups

The patients were stratified into three age groups: the young group (age < 40 years), the middle-aged group (age < 60 but ≥ 40 years), and the elderly group (age ≥ 60 years), with 139 patients in the young group, 221 patients in the middle-aged group, and 172 patients in the elderly group. Among the 249 patients for whom bleeding triggers were recorded, there were 65 cases in the young group, 103 cases in the middle-aged group, and 81 cases in the elderly group. Statistical analysis revealed differences in ANVUGIB triggered by drugs and alcohol among patients in various age groups, while no significant differences were observed in ANVUGIB induced by dietary and psychological factors among patients in different age groups (Table 2).

Table 2 Relationship between acute non-varicose upper digestive hemorrhage pathogenesis and age group.

Age group	Drugs	Alcohol	Diet	Psychological factors
Young group	6	51	7	7
Middle-aged group	36	28	3	9
Elderly group	86	6	5	5
χ2	76.563	35.741	1.600	1.143
P value	0.000	0.000	0.449	0.565

Various causes of ANVUGIB

Upon completion of gastrointestinal endoscopy, it was evident that peptic ulcer disease constituted the vast majority of ANVUGIB cases, accounting for 73.3% (390 cases). Gastrointestinal malignancies comprised 10.9% (58 cases), while acute gastric mucosal lesions represented 9.8% (52 cases). Other contributing factors included duodenal diseases, angiodysplasia, esophageal ulcers, and anastomotic ulcers, collectively amounting to 4.5% (24 cases). Iatrogenic upper gastrointestinal bleeding accounted for 1.5% (8 cases), encompassing post-endoscopic submucosal dissection (ESD)/endoscopic mucosal resection (EMR) bleeding, post-EST bleeding at the duodenal papilla, and post-polypectomy bleeding in the upper gastrointestinal tract.

Among the 390 diagnosed cases of gastrointestinal ulcer bleeding, 213 were attributed to duodenal ulcers, 116 to gastric ulcers, and 53 to compound ulcers involving both gastric and duodenal ulcers. Given the relatively low theoretical frequency, variance analysis based on the age of onset was not conducted for upper gastrointestinal bleeding patients caused by esophageal ulcers, anastomotic ulcers, duodenal diseases, upper gastrointestinal vascular malformations, and iatrogenic factors.

Relationship between causes of ANVUGIB and age of onset

A total of 532 patients with ANVUGIB underwent complete gastrointestinal endoscopy to determine the cause of bleeding. Among them, 139 cases were in the young age group, 221 cases were in the middle-aged group, and 172 cases were in the elderly group. Statistical analysis revealed differences in the causes of gastrointestinal bleeding among the different age groups (Table 3). Further pairwise comparisons using chi-square analysis showed that the comparison of bleeding caused by duodenal ulcers between the young and middle-aged groups was not statistically significant (χ² = 3.841, P = 0.05). However, the incidence rate in both the young and middle-aged groups was higher than that in the elderly group, with significant differences (P < 0.05).

Table 3 Relationship between acute non-varicose upper digestive hemorrhage etiology and age group.

Age group	Duodenal ulcer	Gastric ulcer	Complex ulcer	Cancer	Acute gastric mucosal lesions
Young group	75	18	20	2	23
Middle-aged group	101	48	27	8	25
Elderly group	37	50	6	48	5
χ2	29.183	16.621	12.943	64.690	13.736
P value	0.000	0.000	0.002	0.000	0.001

The comparison of gastric ulcer bleeding between the middle-aged and elderly groups was not statistically significant (χ² = 0.041, P = 0.840), but the incidence rate in both the middle-aged and elderly groups was higher than that in the young group, with significant differences (χ² = 13.363, P < 0.001, χ² = 15.059, P < 0.001). The incidence rate of compound ulcer bleeding was not statistically significant between the young and middle-aged groups (χ² = 1.043, P = 0.307), but it was higher than that in the elderly group, with significant differences (P < 0.05).

The comparison of bleeding caused by upper gastrointestinal malignancies between the young and middle-aged groups was not statistically significant (χ² = 3.600, P = 0.773), but it was significantly lower than that in the elderly group (P < 0.05). Among patients admitted with a diagnosis of acute gastric mucosal lesions, there was no statistical difference between the young and middle-aged groups (χ² = 0.083, P = 0.058), but both were higher than those in the elderly group (P < 0.05).

Therefore, it can be concluded that acute gastric mucosal lesions, duodenal ulcers, and compound ulcers are more common in the middle-aged and young age groups, while gastric ulcers are more common in the middle-aged and elderly groups. The incidence rate of upper gastrointestinal malignancies was significantly higher in the elderly population compared to the middle-aged and young age groups.

Treatment and outcome

Of the 532 patients with gastrointestinal bleeding, a total of 464 patients were diagnosed by endoscopy. These patients either received conservative drug therapy or were promptly referred to other departments for surgery or interventional treatment. Among them, 68 patients who were hemodynamically stable or stabilized after volume expansion underwent endoscopic hemostatic treatment, representing an endoscopic treatment rate of 12.8%. Of the 68 patients who underwent endoscopic hemostasis during gastroscopy, four patients encountered challenges during the procedure for various reasons. Among these, three patients required embolization therapy for hemostasis, while one patient underwent surgical intervention for hemostasis. The remaining 64 bleeding patients achieved immediate hemostasis through endoscopic treatment, resulting in an immediate endoscopic hemostasis rate of 94.1% (Table 4).

Table 4 Statistics of rebleeding after acute non-varicose upper digestive hemorrhage endoscopic hemostasis.

	Number	Percentage
Rebleeding was recorded within 72 h after endoscopic treatment	7	10.9
Rebleeding was recorded 72 h after endoscopic treatment	4	6.3
No further bleeding after endoscopic treatment	53	82.8

DISCUSSION

ANVUGIB represents a grave condition characterized by a high incidence, rebleeding rate, and mortality rate. It has consistently remained a subject of great concern for gastroenterologists and emergency physicians. This study undertook a retrospective analysis of patients diagnosed with ANVUGIB through endoscopic examinations conducted between March 2021 and March 2023 at our hospital. The findings revealed a significantly higher number of male patients compared to female patients, with a male-to-female ratio of 2.91:1. The age of patients ranged from 18 to 94 years, with an average age of 53.34 ± 18.92 years and an average hospital stay of 7.6 ± 4.56 days. In line with previous studies conducted by Yan-Xia Zhang and Rong Han, gender emerged as one of the influencing factors for the occurrence of gastrointestinal bleeding[11,12]. Simplified statistics concerning admission complaints indicated that 43.6% of patients presented with melena as their primary complaint upon admission, while 27.4% presented with hematemesis. Additionally, 17% of patients exhibited both hematemesis and melena upon admission. The majority of ANVUGIB patients sought medical attention with clear complaints of gastrointestinal bleeding, underscoring the importance of vigilance for patients with atypical gastrointestinal bleeding complaints during the clinical assessment. Routine blood examination results at admission revealed that 75.8% of patients exhibited anemia, with 63.4% of them classified as having moderate or more severe anemia. A minority of patients (1.5%) presented with extremely severe anemia (Hb < 30 g/L). The initial routine blood examination upon admission played a crucial role in determining whether patients required immediate blood transfusion therapy. Patients with Hb levels below 70 g/L were considered primary candidates for transfusion therapy[5].

In recent years, there has been a notable surge in drug-related acute gastric mucosal lesions and bleeding, specifically associated with medications such as aspirin and heparin. This trend can be attributed to the aging population and the heightened prevalence of cardiovascular and cerebrovascular diseases among the elderly. Cai et al[13] conducted a study involving 253 patients with acute gastric mucosal lesions, where 153 cases (60.47%) were linked to NSAIDs and anticoagulant drugs. Notably, the incidence ratio between the first five years and the last five years exhibited statistical significance (P < 0.05). In this investigation, upon categorizing the patients into different age groups, it was revealed that 53.2% of the patients experienced bleeding without any apparent triggers beforehand, while nearly half of the patients had identifiable triggers preceding the bleeding episode. Among this latter group, 24.2% of the patients were using aspirin, NSAIDs, corticosteroids, chemotherapy drugs, and molecularly targeted drugs known to stimulate and damage the gastric mucosa, along with patients taking anticoagulant medications such as warfarin and rivaroxaban, which impact coagulation function. These individuals were primarily middle-aged and elderly, further reinforcing the aforementioned findings. Moreover, patients with a history of alcohol consumption accounted for 15.8% of cases before the onset of bleeding. Subsequent subgroup analysis indicated that the rise in the proportion of ANVUGIB in the younger age group was primarily linked to digestive ulcers and acute gastric mucosal lesions caused by alcohol consumption in this demographic.

Further research conducted among the different age groups revealed variations in the etiology of gastrointestinal bleeding. When comparing bleeding caused by duodenal ulcers between the young and middle-aged groups, no statistically significant difference was observed (χ² = 3.841, P = 0.05). However, the incidence rates were higher in both the young and middle-aged groups when compared to the elderly group, and these differences were statistically significant (P < 0.05). Similarly, when examining gastric ulcer bleeding between the middle-aged and elderly groups, no statistical significance was found (χ² = 0.041, P = 0.840). Nevertheless, the incidence rates of gastric ulcer bleeding were notably higher in both the middle-aged and elderly groups in comparison to the young group, and these disparities were statistically significant (χ² = 13.363, P < 0.001, χ² =15.059, P < 0.001). The incidence rate of combined ulcer bleeding showed no statistical significance between the young and middle-aged groups (χ² = 1.043, P = 0.307), but it was significantly elevated in both of these groups when compared to the elderly group, with statistically significant differences (P < 0.05). Furthermore, when comparing patients with upper gastrointestinal malignant tumors causing bleeding between the young and middle-aged groups, no statistical significance was observed (χ² =3.600, P = 0.773). However, both of these groups exhibited significantly lower incidence rates when compared to the elderly group, with statistically significant differences (P < 0.05). In conclusion, it can be deduced that acute gastric mucosal lesions, duodenal ulcers, and combined ulcers are more prevalent in the middle-aged and young groups, while gastric ulcers are more common in the middle-aged and elderly groups. Additionally, the incidence rate of upper gastrointestinal malignant tumors is notably higher among the elderly population as compared to the middle-aged and young groups.

Furthermore, as endoscopic technology continues to advance and the number of endoscopic procedures performed rises, iatrogenic gastrointestinal bleeding has been increasingly identified as a notable complication during and after surgeries. In this retrospective analysis, iatrogenic upper gastrointestinal bleeding constituted 1.5% of cases (8 instances), encompassing post-ESD/EMR bleeding, bleeding following EST procedures in the duodenal papilla, and post-endoscopic polypectomy bleeding in the upper gastrointestinal tract. A comprehensive literature review disclosed noteworthy discrepancies in the incidence of intraoperative and postoperative bleeding associated with ESD/EMR across different medical centers[14-17]. This analysis suggests that the substantial variations in occurrence rates might be attributed to various factors, such as differing definitions of bleeding complications employed by different physicians, the extent of submucosal dissection, and the extent of electrocoagulation applied to the wound surface after dissection.

Several previous studies[18-22] have affirmed the therapeutic efficacy of gastrointestinal endoscopy in the management of ANVUGIB. It has been shown to significantly enhance treatment outcomes, reduce the treatment duration, and improve Hb levels. In this particular investigation, conducted among a cohort of 532 patients with gastrointestinal bleeding, a total of 68 patients underwent endoscopic hemostatic procedures, representing a utilization rate of 12.8% for endoscopic treatment. The indications for endoscopic treatment predominantly included pulsatile bleeding, oozing, exposure of blood vessels, and identification of the primary bleeding site following the removal of blood clots due to various etiologies. Among the 68 patients who underwent endoscopic hemostasis via gastroscopy, four cases encountered challenges in achieving hemostasis through endoscopy due to various factors. Within this subgroup, three patients underwent embolization therapy to achieve hemostasis, while one patient required surgical intervention for hemostasis. Among the remaining 64 patients experiencing bleeding, immediate hemostasis was successfully achieved through endoscopic treatment, resulting in an impressive immediate endoscopic hemostasis rate of 94.1%. These results underscore the effectiveness of endoscopic hemostatic treatment for upper gastrointestinal bleeding. However, it is crucial to remain vigilant against the possibility of rebleeding.

CONCLUSION

In summary, this retrospective study examined the data of patients diagnosed with ANVUGIB by endoscopic examination at our hospital. The results highlighted the distinct characteristics among ANVUGIB patients of different age groups. Although this study was conducted at a single center, it is noteworthy that the age and gender distribution of the patients in this study closely mirrored those reported in previous multicenter studies conducted in China. Furthermore, the therapeutic impact of endoscopic hemostatic treatment was studied, and was found to be effective in managing ANVUGIB, enhancing treatment outcomes, and warrants wider application.

ARTICLE HIGHLIGHTS

Research background

Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) constitutes a prevalent emergency within Gastroenterology, encompassing 80%-90% of all gastrointestinal hemorrhage incidents. This condition is distinguished by its abrupt onset, swift progression, and notably elevated mortality rate.

Research motivation

This research was designed to collect clinical data from patients experiencing ANVUGIB at our hospital. The objective was to identify clinical features unique to our institution and to evaluate the efficacy of endoscopic hemostasis treatment.

Research objectives

The aim is to clarify the distinct clinical characteristics associated with our institution and to assess the therapeutic efficacy of endoscopic hemostasis.

Research methods

We conducted a retrospective analysis of 532 patients diagnosed with ANVUGIB via endoscopy at our hospital from March 2021 to March 2023, utilizing our electronic medical records system. Data encompassing general patient demographics, etiological factors, clinical outcomes, and other pertinent variables were scrupulously gathered and examined.

Research results

In the cohort of 532 patients diagnosed with ANVUGIB, the male-to-female ratio was 2.91:1, indicating a higher incidence in males. Notably, 43.6% of these patients reported black stool as their primary symptom, while 27.4% initially presented with hematemesis. On admission, 17% of patients showed symptoms of both hematemesis and black stool. The majority of ANVUGIB patients primarily complained of overt gastrointestinal bleeding. Urgent hematological assessments upon admission revealed that 75.8% of the patients were anemic, with 63.4% suffering from moderate to severe anemia, and 1.5% exhibiting extremely severe anemia (Hemoglobin < 30 g/L). Etiologically, 53.2% experienced bleeding without an identifiable trigger, 24.2% had a history of ingesting gastric mucosa-irritating medications, 24.2% developed bleeding post alcohol consumption, 2.8% linked their bleeding to improper diet, 1.7% to emotional excitement, and 2.3% to fatigue prior to the bleeding episode. Drug-induced ANVUGIB was more common in the elderly compared to middle-aged and younger individuals, while alcohol-related bleeding was more frequent in younger patients. Moreover, diet-related bleeding incidents were predominantly observed in the younger demographic compared to middle-aged individuals. Gastrointestinal endoscopy revealed peptic ulcers as the leading cause of ANVUGIB, accounting for 73.3% of cases, followed by gastrointestinal malignancies (10.9%), acute gastric mucosal lesions (9.8%), and androgenic upper gastrointestinal bleeding (1.5%). Of the 532 patients with gastrointestinal bleeding, 68 underwent endoscopic hemostasis, representing a treatment rate of 12.8%, with a notably high immediate hemostasis success rate of 94.1%.

Research conclusions

Patients across various age groups present with distinct characteristics, and endoscopic hemostatic treatments showed significant efficacy.

Research perspectives

This retrospective analysis focused on patients diagnosed with ANVUGIB via endoscopic examination at our hospital. The study underscored the unique characteristics of ANVUGIB patients across various age demographics. Additionally, it determined the therapeutic effectiveness of endoscopic hemostatic treatment, affirming its efficiency in managing ANVUGIB, improving treatment outcomes, and advocating for its wider implementation.