From the Guidelines
African Americans have the highest incidence of gastrointestinal (GI) bleeds compared to other racial groups. Studies have shown that African Americans experience higher rates of both upper and lower GI bleeding events 1. This racial disparity is attributed to several factors, including higher prevalence of risk factors such as hypertension, diabetes, and H. pylori infection among African Americans. Additionally, socioeconomic factors affecting access to preventive care and early intervention likely contribute to these disparities. African Americans also tend to have higher rates of NSAID use and are more likely to develop complications from medications that increase bleeding risk.
Key Factors Contributing to GI Bleeds in African Americans
- Higher prevalence of hypertension and diabetes
- Increased rates of H. pylori infection
- Socioeconomic factors affecting access to care
- Higher rates of NSAID use
Preventive Measures for High-Risk Patients
- Using gastroprotective agents like proton pump inhibitors when on NSAIDs or anticoagulants
- H. pylori testing and treatment when indicated
- Regular screening for colorectal cancer Understanding these racial disparities is important for healthcare providers to implement appropriate preventive strategies and early interventions for at-risk populations, as seen in recent international consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding 1.
From the Research
Gastrointestinal Bleeding by Race
- The study 2 analyzed 2196 patients admitted with acute upper gastrointestinal hemorrhage (UGIH) and found that:
- Blacks experienced a high rate of gastroduodenal ulcers (199/620)
- Hispanics most commonly had esophageal varices
- Whites had a lower rate of rebleeding (5.8%) compared to Hispanics (9.9%) or blacks (8.7%)
- The same study found that among patients aged 35 to 64 years, there were differences in the etiology of UGIH:
- Blacks aged 50 to 64 years frequently experienced gastroduodenal ulcers
- Hispanics aged 35 to 49 years typically had esophageal varices
- Another study 3 discussed the management of gastrointestinal bleeding, but did not provide specific information on the incidence of GI bleeds by race.
- Studies 4, 5, and 6 also did not provide specific information on the incidence of GI bleeds by race.
Incidence of GI Bleeds by Race
- Based on the available evidence, it appears that:
- Blacks have a high incidence of gastroduodenal ulcers
- Hispanics have a high incidence of esophageal varices
- Whites have a lower rate of rebleeding compared to Hispanics or blacks
- However, more research is needed to confirm these findings and to determine the incidence of GI bleeds by race in different populations.