Introduction
Alcohol abuse is a significant risk factor for the development of hepatic cirrhosis, which can lead to upper gastrointestinal bleeding. In non-cirrhotic patients, alcohol has been studied as a risk factor for non-variceal upper gastrointestinal bleeding (NVUGI), particularly in cases of peptic ulcer bleeding (1). However, the clinical impact of alcohol abuse on outcomes remains unclear. Only one retrospective study has analyzed this, finding an increased risk of rebleeding and non-significant increased mortality among alcohol consumers (2). Nevertheless, this study included cirrhotic patients, who accounted for most of the mortality. There is currently no available data on the impact of alcohol on NVUGI outcomes in non-cirrhotic patients.
Aims & Methods
This study aims to determine the impact of alcohol consumption on clinical outcomes in NVUGI.
We conducted a retrospective analysis at a Spanish tertiary hospital, encompassing NVUGI cases from 2013 to 2022. Alcohol abuse was defined as daily alcohol intake exceeding 20g. Key clinical outcomes included the need for intervention (transfusion, endoscopic, radiological, or surgical) and in-hospital mortality. In addition, we compared baseline characteristics and assessed both acute and delayed 6 months outcomes, including rebleeding and delayed cardiovascular events. Statistical analysis was performed using SPSS.
Results
A total of 892 cases were included. The alcohol abuse group had a higher proportion of men (95.6% vs. 64.1%, p < 0.001) and were younger (median age of 56 years vs. 66 years, p < 0.001). Non-alcohol consumers had more comorbidities and a higher ASA comorbidity risk score (58% had ASA 3 or 4 vs. 46% in the other group, p = 0.015). Additionally, the MAP(ASH) score was higher in the first group (>2 in 54.5% vs. 46.3%, p = 0.030). We did not find any other differences between groups, neither in key outcomes nor in the remaining comparisons for the acute episode. However, delayed mortality (8,2% in group 1 vs 3,1% in group 2, p=0,046) and six months cardiovascular events (8,9% vs 2,3%, p=0,011) were more frequent in the non-alcohol group. In multivariate analysis, only ASA 3-4 (OR: 4.17, CI: 1.49-11.68, p= 0.006) and MAP(ASH) (OR: 7.61, CI: 2.54-22.8, p < 0.001) were found to be independent risk factors for acute mortality.
| | No Alcohol | Alcohol | p |
| Age | 66,75 | 56,88 | <0,001 |
| Sex | Men 464 (61,4%) | Men 130
(95,6%) | <0,001 |
| Chronic obstructive pulmonary disease | 75 (9,9%) | 13 (9,6%) | 0,896 |
| Chronic renal disease | 126 (16,7%) | 6 (4,4%) | <0,001 |
| Heart faliure | 91 (12%) | 6(4,4%) | 0,009 |
| High blood pressure | 368(48,7%) | 52 (38,2%) | 0,071 |
| Diabetes mellitus | 182 (24,1%) | 19 (14%) | 0,009 |
| Smooking | 95 (12,6%) | 69 (50,7%) | <0,001 |
| MAPASH >2 | 334 (54,5%) | 49 (43,4%) | 0,030 |
Conclusion
Alcohol abuse is more common among younger individuals with fewer comorbidities. This consumption does not worsen clinical outcomes in non-cirrhotic NVUGI patients, with similar rates of need for intervention or mortality. Our results indicate that only comorbidities and bleeding severity (summarized as high ASA score and MAP(ASH)) score influence the outcomes. In summary, while alcohol consumption may increase the risk of NVUGI incidence, it does not impact acute outcomes.
References
- Kelly JP, Kaufman DW, Koff RS, Laszlo A, Wiholm BE, Shapiro S. Alcohol consumption and the risk of major upper gastrointestinal bleeding. Am J Gastroenterol. 1995 Jul;90(7):1058-64.
- Kärkkäinen JM, Miilunpohja S, Rantanen T, Koskela JM, Jyrkkä J, Hartikainen J, Paajanen H. Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding. Dig Dis Sci. 2015 Dec;60(12):3707-15
