Gastrointestinal bleeding (GIB) remains one of the leading causes of emergency hospital admission for gastrointestinal disorders and continues to represent a major source of morbidity and mortality, particularly in aging populations, where widespread use of antithrombotic and anticoagulant agents increases bleeding risk. Long-term population-based data on GIB hospitalizations in Europe are limited. This study assessed 25-year trends in hospitalization rates for upper (U-GIB), lower (L-GIB), and undefined GIB (UN-GIB) in the Veneto Region, in Northeastern Italy.

All GIB admissions from 2000 to 2024 were identified through regional Hospital Discharge Records using ICD-9-CM codes. Age- and sex-standardized hospitalization rates (HRs) per 100,000 residents were calculated annually. Temporal trends were evaluated using Joinpoint regression and expressed as average annual percent change (AAPC).

A total of 99,731 GIB admissions were recorded, including 46.6% U-GIB, 39.5% L-GIB, and 13.9% UN-GIB. The standardized hospitalization rate (HR) decreased from 122.4 to 55.0 per 100,000 population (AAPC −3.6%; 95% CI −3.9 to −3.4; p < 0.001) from 2000 to 2024. U-GIB declined from 76.3 to 20.1 per 100,000 (AAPC −5.98%; 95% CI −6.46 to −5.50; p<0.001), L-GIB from 30.7 to 28.0 per 100,000 (AAPC −0.92%; 95% CI −1.31 to −0.53; p<0.001), and UN-GIB from 15.3 to 6.8 per 100,000 (AAPC −3.64%; 95% CI −4.26 to −3.02). L-GIB exceeded U-GIB from 2011 onwards, in 2008 among females and 2018 among males. Hospitalization rates were consistently higher in males across all bleeding sites. Age-specific rates rose progressively with age, with L-GIB surpassing U-GIB in individuals aged ≥85 years and earlier in females (65–74 years).

GIB hospitalizations in the Veneto region declined by more than half over 25 years, driven by a steep reduction in U-GIB and a modest decrease in L-GIB. L-GIB has become the most frequent bleeding site, with clear age- and sex-related differences. These long-term trends indicate a shifting epidemiologic burden that should guide future preventive and diagnostic strategies.