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Severe Upper Gastrointestinal Hemorrhage Caused by Reflux Esophagitis

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Abstract

Background

There are few reports about reflux esophagitis (RE) as a cause of severe upper gastrointestinal bleeding (UGIB).

Aims

This study aims to evaluate (1) changes in its prevalence over the last three decades and (2) clinical and endoscopic characteristics and 30-day outcomes among RE patients with and without focal esophageal ulcers (EUs) and stigmata of recent hemorrhage (SRH).

Methods

A retrospective study of prospectively collected data of esophagitis patients hospitalized with severe UGIB between 1992 and 2020. Descriptive analysis and statistical comparisons were performed.

Results

Of 114 RE patients, the mean age was 61.1 years and 76.3% were males. 38.6% had prior gastroesophageal reflux disease (GERD) symptoms; overall 36% were on acid suppressants. Over three consecutive decades, the prevalence of RE as a cause of severe UGIB increased significantly from 3.8 to 16.7%. 30-day rebleeding and all-cause mortality rates were 11.4% and 6.1%. RE patients with focal EUs and SRH (n = 23) had worse esophagitis than those with diffuse RE (n = 91) (p = 0.012). There were no differences in 30-day outcomes between RE patients with and without EUs and SRH.

Conclusions

For patients with severe UGIB caused by RE, (1) the prevalence has increased significantly over the past three decades, (2) the reasons for this increase and preventive strategies warrant further study, (3) most patients lacked GERD symptoms and did not take acid suppressants, and (4) those with focal ulcers and SRH had more severe esophagitis and were treated endoscopically.

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Acknowledgments

This study was funded by VA Clinical Merit Review Research Grants (Grant Numbers CLIN-013-07F and 5I01CX001403), and NIH (Grant numbers NIDDK P30DK41301 CURE DDRCC (Human Studies Core)).

Author information

Authors and Affiliations

  1. CURE: Digestive Diseases Research Core Center (CURE: DDRCC), Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA

    Peerapol Wangrattanapranee, Usah Khrucharoen, Dennis M. Jensen, Thongsak Wongpongsalee & Mary Ellen Jensen

  2. Gastroenterology Division, Department of Medicine, VA Greater Los Angeles Healthcare System, Building 115, Room 318, 11301 Wilshire Boulevard, Los Angeles, CA, 90073-1003, USA

    Peerapol Wangrattanapranee, Usah Khrucharoen, Dennis M. Jensen & Mary Ellen Jensen

  3. Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA

    Usah Khrucharoen, Dennis M. Jensen, Thongsak Wongpongsalee & Mary Ellen Jensen

  4. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, 13th Floor, Syamindra Building, 2 Prannok Road, Bangkok, 10700, Thailand

    Thongsak Wongpongsalee

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  1. Peerapol Wangrattanapranee
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  2. Usah Khrucharoen
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  3. Dennis M. Jensen
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  4. Thongsak Wongpongsalee
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  5. Mary Ellen Jensen
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Contributions

DMJ was responsible for supervision, conceptualization, methodology, and funding acquisition. Data acquisition was performed by PW and UK. Data analysis was performed by PW, TW, and MEJ. PW was involved in writing the first draft of the manuscript, and all authors critically revised the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Dennis M. Jensen.

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Conflict of interest

The authors declare that they have no conflict of interest and no assistance in manuscript preparation.

Ethical approval

All patients had been enrolled in Institutional Review Board (IRB)-approved prospective cohort or randomized studies of severe UGI hemorrhage at both VA Greater Los Angeles Healthcare System and University of California, Los Angeles. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wangrattanapranee, P., Khrucharoen, U., Jensen, D.M. et al. Severe Upper Gastrointestinal Hemorrhage Caused by Reflux Esophagitis. Dig Dis Sci 67, 159–169 (2022). https://doi.org/10.1007/s10620-021-06828-3

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  • DOI: https://doi.org/10.1007/s10620-021-06828-3

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