HEALTH MATTERS: study shows more Scottish patients surviving potentially fatal bleeds

By Rory Murphy

More patients in Scotland are surviving serious upper gastrointestinal bleeds, according to a study led by specialists at Glasgow Royal Infirmary and Glasgow University.

The hospital is widely recognised as a world leader in the treatment of upper GI bleeding – which is a condition where patients vomit or pass blood. This is usually due to a stomach ulcer, significant inflammation in the upper gastrointestinal tract or swollen blood vessels in the gullet as a result of liver disease. In Scotland, around 8,000 patients suffer and upper GI bleed each year.

This recent study, published in Alimentary Pharmacology & Therapeutics, reported that the mortality of almost 130,000 patients who were admitted to Scottish hospitals with this common medical emergency fell from 10.1% to 7.9% over a fifteen-year period.

Professor Adrian Stanley, pictured right, senior author of the study and a Consultant Gastroenterologist based at the Royal said: “Despite the rising average age of Scottish patients presenting with upper GI bleeding over this 15-year period, mortality fell by 22% over the same time.

“We believe there are a number of reasons why more people are surviving compared to 15 years ago. These include research and developments in optimal resuscitation techniques and blood transfusion strategies, early access to endoscopy to treat active bleeding, and the use of intravenous medication to reduce stomach acid.

“There was also a significant reduction over the study period in the length of hospital stay for patients, from 3.9 to 2.1 days. This is good news for patients, as most would rather recuperate at home when it is safe to do so.

“There had been some concerns that admission at weekends could lead to poorer outcomes for some emergency conditions. However, our study found no difference in outcome when comparing week-day and weekend admissions, which is very reassuring.”

Glasgow Royal Infirmary and the University of Glasgow have a long and proud history in the management of upper GI bleeding, with local specialists publishing many high-profile research studies on the subject.  The new European guidelines on this condition have also just been published, and the only two UK clinicians invited to take part are both from Glasgow Royal – Professor Stanley and Dr John Morris.

Glasgow is also the birthplace of a scoring system to identify higher risk patients who will need more urgent management following upper GI bleeding. The Glasgow Blatchford Score was developed by Dr Oliver Blatchford in 2000, and its calculation in all patients presenting with upper GI bleeding is now recommended by every major international guideline on this condition.

Professor Stanley said: “This is an example of Glasgow clinical research changing medical practice internationally, leading to improved management of patients around the world.”

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