Lower gastrointestinal bleeding epidemiology and demographics
Jump to navigation
Jump to search
|
Lower gastrointestinal bleeding Microchapters |
|
Differentiating Lower gastrointestinal bleeding from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Management |
|
Surgery |
|
Case Studies |
|
Lower gastrointestinal bleeding epidemiology and demographics On the Web |
|
American Roentgen Ray Society Images of Lower gastrointestinal bleeding epidemiology and demographics |
|
FDA on Lower gastrointestinal bleeding epidemiology and demographics |
|
CDC on Lower gastrointestinal bleeding epidemiology and demographics |
|
Lower gastrointestinal bleeding epidemiology and demographics in the news |
|
Blogs on Lower gastrointestinal bleeding epidemiology and demographics |
|
Risk calculators and risk factors for Lower gastrointestinal bleeding epidemiology and demographics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Muhammad Saad, M.D.[2] Aditya Ganti M.B.B.S. [3]
Epidemiology and demographics
Incidence
- The estimated population incidence of acute lower gastrointestinal bleeding (LGIB) is approximately **33–87 per 100,000 population**, although epidemiologic studies are heterogeneous and high-quality population-based data remain limited.[1][2]
- US hospitalization incidence is approximately **36 per 100,000 population per year**.[3]
- LGIB incidence has increased relative to upper gastrointestinal bleeding (UGIB) in several population-based cohorts. In a Finnish cohort, LGIB occurred at 1.26 versus 0.94 per 1,000 person-years for UGIB; in a Hong Kong cohort, LGIB also surpassed UGIB over time, with the steepest increase among adults older than 80 years.[1]
- Proposed contributors to the increasing burden of LGIB include an aging population and greater exposure to antithrombotic medications.[1][2]
Healthcare utilization and hospital burden
- In the United States in 2018, LGIB accounted for approximately **271,575 emergency department visits** and **113,020 hospital admissions** as a primary diagnosis.[1][2]
- LGIB accounts for up to approximately **30% of major gastrointestinal bleeding episodes**.[3]
- Contemporary LGIB admissions involve an increasingly older and more comorbid population, with greater overall healthcare complexity than in earlier eras.[1]
Temporal trends
- In US emergency department data from 2006–2019, age- and sex-adjusted LGIB incidence increased from **146.0 per 100,000 in 2006** to a peak of **161.0 per 100,000 in 2015**, then declined to **150.2 per 100,000 in 2019**.[4]
- During the same period, the proportion of patients with at least 1 comorbidity increased from **27.4% to 35.9%**.[4]
- Compared with 2006, patients presenting in 2019 had more ED discharges and fewer RBC transfusions, endoscopic procedures, deaths, and shorter hospital stays.[4]
- The etiologic composition also changed. Diverticular bleeding declined overall by **17.2%**, from 37.6 to 31.2 per 100,000, although it increased by 8.8% between 2016 and 2019. Other non-diverticular bleeding increased by **18.0%** over the study period.[4]
- International trends are not uniform. Spanish data reported an increase in LGIB hospitalization incidence from approximately **20 to 33 per 100,000** between 1996 and 2005, whereas US emergency department data show a decline after 2015.[2][4]
Cost and healthcare burden
- In US emergency department data, inflation-adjusted inpatient cost per GI-bleeding encounter decreased from 2012 to 2019 (relative ratio 0.92; 95% CI 0.91–0.93).[4]
- Aggregate healthcare costs for LGIB may exceed those for UGIB, with inpatient hospitalization accounting for most of the expenditure.[2]
Demographics
- Age: LGIB predominantly affects older adults. In the first UK nationwide LGIB audit of 2,528 patients, the median age was **74 years (IQR 57–83)**, compared with 68 years in the parallel UK UGIB audit.[5]
- LGIB incidence increases substantially with age, with particularly rapid growth among adults older than 80 years.[1][2]
- Age-related increases in conditions associated with LGIB, including diverticulosis and ischemic colonic disease, contribute to the burden among older adults.[1][6]
- Sex: Current high-level evidence does not establish a robust sex difference in LGIB incidence. Male sex has been associated with higher mortality and is better regarded as a demographic prognostic marker than as a definitive incidence difference.[2]
- Antithrombotic exposure: In the UK nationwide audit, **29.4%** of patients were taking antiplatelet agents and **15.9%** were taking anticoagulants, illustrating the substantial prevalence of antithrombotic exposure among patients presenting with LGIB.[5]
- Comorbidity: Patients with LGIB commonly have substantial comorbidity. Advanced age, higher comorbidity burden, long-term anticoagulation, and hypovolemia are associated with increased mortality.[2]
- Pediatrics: Pediatric lower gastrointestinal bleeding has a distinct epidemiologic and etiologic spectrum and should not be extrapolated from adult LGIB data.
Epidemiologic limitations
- Current epidemiologic estimates are definition-dependent. Modern LGIB definitions distinguish colorectal-source bleeding from small-bowel (mid-GI) bleeding, which should not be combined when comparing incidence or population burden.[1][2]
- High-quality population-based epidemiologic studies remain limited, accounting for the wide estimated incidence range of **33–87 per 100,000**.[1]
- Whether LGIB incidence is uniformly increasing globally remains uncertain because temporal trends differ across countries and study periods.[2][4]
- Current high-level sources do not provide sufficiently robust evidence to establish a clinically reliable racial or ethnic incidence differential; therefore, no definitive race/ethnicity association is stated.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Sengupta N, Feuerstein JD, Jairath V; et al. (2023). "Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline". The American Journal of Gastroenterology. 118 (2): 208–231. doi:10.14309/ajg.0000000000002130.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 Alali AA, Almadi MA, Barkun AN (2024). "Review article: Advances in the management of lower gastrointestinal bleeding". Alimentary Pharmacology & Therapeutics. 59 (5): 632–644. doi:10.1111/apt.17859.
- ↑ 3.0 3.1 Aaron AE, Amabile A, Andolfi C, et al. Gastrointestinal Surgical Emergencies Textbook. American College of Surgeons. 2021.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Zheng NS, Tsay C, Laine L, Shung DL (2022). "Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019". Alimentary Pharmacology & Therapeutics. 56 (11–12): 1543–1555. doi:10.1111/apt.17238.
- ↑ 5.0 5.1 Oakland K, Guy R, Uberoi R; et al. (2018). "Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit". Gut. 67 (4): 654–662. doi:10.1136/gutjnl-2016-313428.
- ↑ Pilotto A, Custodero C, Crudele L; et al. (2026). "Age-Related Changes of the Gastrointestinal Tract". The Lancet Gastroenterology & Hepatology. 11 (1): 59–70. doi:10.1016/S2468-1253(25)00235-3.