Gastro-protective policy and the incidence of upper gastrointestinal bleeding

Abstract

ObjectivesIn recent years, policies have been proposed in order to guide the safer use of non-steroidal anti-inflammatory drugs (NSAIDs) and antiulcer therapy. We aimed to investigate the incidence of upper gastrointestinal bleeding (UGIB) before and after the introduction of these policies, 2007–2009, in a well-defined population in southwest Scotland.MethodsAll patients with non-variceal upper gastrointestinal bleeding (NV-UGIB), diagnosed at a single regional unit, were included. Total drugs prescribed in our population were noted, including antiulcer drugs, antithrombotic drugs and both cyclo-oxygenase-2 enzyme-selective and non-selective inhibiting NSAIDs.ResultsThe incidence, the number of cases per 100 000 population per annum, of NV-UGIB fell from 134.7 in 2007 to 125.1 in 2008, and to 90.3 cases in 2009 (p<0.001). There was also a significant rise in the use of non-selective NSAIDs, proton pump inhibitors and antithrombotic drugs.ConclusionsAlthough a cause-and-effect relationship cannot be fully proven, physician education through drug-use policies is associated with a drop in the incidence of NV-UGIB. This is relevant to the prevention of this common condition.

Upper gastrointestinal bleeding in hospital inpatients: the role of antithrombotic drugs

“…14 Despite the substantial statistical and clinical heterogeneity in the published literature linking C. difficile to acid inhibitors,15 the regulatory authorities still recommend caution in the use of such drugs 14. However, our findings would suggest that it would be worthwhile considering using prophylactic antiulcer therapy in elderly inpatients with cardiovascular disease and being treated with antithrombotic drugs 10 13 16…”

“…The work took place between 1 January 2008 and 31 December 2009 at University Hospital Crosshouse, Scotland (box 1). This work is part of our ongoing programme that investigates the epidemiology and management of upper GI bleeding 9 10…”

“…Patients who have endoscopic evidence of a portal hypertensive cause for their upper GI bleed (oesophageal varices, gastric varices or portal hypertensive gastropathy) were excluded from further analysis. Causes of NVGIB included gastric or duodenal ulcers or erosions, erosive gastritis, Mallory-Weiss lesions, erosive oesophagitis, idiopathic angiodysplasia and UGI tract tumours and malignancies 9 10. Patients with normal oesophago-gastro-duodenoscopy (OGD) following haematemesis would undergo angiography using CT if their bleeding persists and remains unexplained.…”

“…The postendoscopic complete Rockall score (table 1) for acute NVGIB was used as previously described 9 10. Calculating this score involves the allocation of numerical values to each of five components such that the maximum score is 11.…”

The ibuprofen–famotidine combined pill – a promise fulfilled

“…Like other NSAIDs, ibuprofen may cause dyspeptic symptoms and gastro-duodenal ulcers and erosions. Some of these lesions might be totally silent, i.e., asymptomatic, or they can result in serious complications including bleeding, perforation, obstruction or, sometimes, death 4,5 . In addition, the cardio-vascular side effects of NSAIDs have recently been of particular interest to the regulatory authorities such as the Food and Drug Administration, USA.…”