Acute upper gastrointestinal bleeding in the UK: patient characteristics, diagnoses, and outcomes in the 2022 prospective audit of 5000 patients

Aims: With the evolving landscape of acute upper GI bleeding (AUGIB) management, a comprehensive understanding of changing clinical outcomes becomes imperative. This report presents findings from the 2022 UK-wide multi-centre AUGIB audit, drawing comparisons to the previous 2007 study. Methods: A prospective multi-centre audit, conducted between May 3 and July 2, 2022, included adults (≥16 years) presenting with AUGIB in UK hospitals. Results: Data on 5101 patients (median age 69yr) from 152 participating hospitals are reported. New admissions with AUGIB (n=3905) were younger than inpatients developing AUGIB (median age 67.5 vs 74 yrs, respectively) with fewer comorbidities (63% vs 80%, respectively). At presentation, 17% (877/5101) had chronic liver disease (CLD), 30% (n=1528) a history of regular alcohol use, 7% (n=371) were taking non-steroidal anti-inflammatory drugs and 46%(n=2339) antiplatelets and/or anticoagulants (18% direct oral anticoagulants, 10% heparin and 3% warfarin). 83%(n=4228) patients had an inpatient endoscopy; 30%(1277/4228) had peptic ulcer disease (PUD), 9%(417/4228) had varices, and 27%(1135/4228) received endoscopic therapy. Reasons for no endoscopy (n=873) were: 56%(n=491) not clinically indicated/27%(n=234) outpatient procedure /18%(n=156) not for active treatment /7%(n=64) self-discharged /1%(n=7) transferred to other hospital /6%(n=51) death. 10% (416/4228) had evidence of further in-patient bleeding after index endoscopy. 9%(440) underwent>1 endoscopy during inpatient stay; 0.8%(n=42) underwent surgery, 2.6%(n=134) had interventional radiology (IR) and 49%(n=2511) were transfused≥1 packed red blood cells; 4%(n=212) platelets; and 5%(n=282) fresh frozen plasma for AUGIB. Median length of stay was 5 days (IQR 3-9). In-hospital mortality was 9%(n=461); 5.7% in new admissions and 18.4% in inpatients. Comparisons with the 2007 audit revealed significant differences in patient profiles in 2022, including an increase in comorbid patients (67% vs 50%), higher prevalence of anticoagulant use (31% vs 13%), and a greater proportion with underlying CLD (17% vs 9%). A higher percentage of patients underwent inpatient endoscopy (83% vs 74%) in 2022, with reductions in PUD (30% vs 36%) and varices (9% vs 11%). There was a significant increase in those receiving endotherapies (27% vs 24%) and undergoing IR procedures (2.6% vs 1.2%), along with a lower likelihood of further in-patient bleeding after an index endoscopy (10% vs 13%), surgery (0.8% vs 1.9%), and in-hospital mortality (9% vs 10%). All differences were found to be statistically significant (p<0.05). Conclusions: Despite a more co-morbid population, there was reduced recurrent bleeding, need for surgery and in-hospital mortality for AUGIB since 2007. These improvements may be associated with improved management and better endoscopic therapy.