The primary aim of this study is to compare the demographic characteristics, etiological profile, and short-term clinical outcomes of patients with upper gastrointestinal bleeding (UGIB) admitted to our institution in 2004 and 2024. This analysis is based on evidence that the epidemiological landscape of UGIB has undergone substantial changes over the last two decades.

A descriptive and comparative analysis was performed on two cohorts of all patients diagnosed with UGIB who underwent upper gastrointestinal endoscopy during a 1-year period at our center: one from 2004 (n=280) and one from 2024 (n=216). Demographic, clinical, and prognostic variables were compared. Appropriate statistical tests were applied to compare the groups, and results were considered statistically significant when p<0.05.

The comparative analysis between the 2004 and 2024 cohorts showed a significant aging of the patient population (mean age: 67.5 vs. 72.9 years; p<0.001). At the same time, there was a substantial increase in the prevalence of major comorbidities, including cerebrovascular disease (5.7% vs. 19.4%; p<0.001) and chronic kidney disease (2.5% vs. 13.6%; p<0.001). Therapeutic complexity also increased, with a significant increase in the use of anticoagulants (4.3% [exclusively vitamin K antagonists - VKA] vs. 30% [VKA + DOACs]; p<0.001).

Regarding clinical presentation, there was an increase in syncope as a form of presentation (7.9% vs. 13.5%; p=0.021) and a decrease in the frequency of classic presentations, such as hematemesis (58.6% vs. 41.2%; p<0.001) and melena (67.9% vs. 59.5%; p=0.028). Etiologically, peptic ulcer remained the main cause of upper gastrointestinal bleeding (46.8% vs. 46.3%; p=0.457), although there was a reduction in active bleeding stigmata (Forrest Ia/Ib: 11% vs. 5.6%; p=0.006). In contrast, there was a notable increase in angiectasias (0.4% vs. 6.5%; p<0.001) and neoplasms (3.9% vs. 9.3%; p=0.008).

This more severe profile was reflected in a significant increase in the mean Rockall score (4.76 vs. 5.65; p<0.001). However, despite this worsening of the baseline risk profile, immediate clinical outcomes remained stable, with no statistically significant differences in the rate of hemorrhagic recurrence (3.2% vs. 3.8%; p=0.358), the need for surgical intervention (2.1% vs. 2.2%; p=0.484), or in in-hospital mortality (8.9% vs. 6.5%; p=0.165).

Over the course of two decades, the profile of patients admitted with upper gastrointestinal bleeding (UGIB) at our institution has changed substantially. Currently, the cohort is older, has a higher burden of associated comorbidities, and has a significantly higher prevalence of anticoagulant therapy. This change in the baseline profile is directly reflected in the etiology of bleeding, namely through an increase in neoplastic etiology (now the third most frequent cause) and bleeding due to angiectasias. Despite the increased baseline risk of patients, as evidenced by the higher mean Rockall score, immediate outcomes remained unchanged. This finding suggests that advances in contemporary clinical treatment and endoscopic intervention protocols have been effective and crucial in mitigating this increased risk.