Overall mortality among patients surviving an episode of peptic ulcer bleeding

Abstract

Study objective-The authors investigated whether patients who have survived an acute episode of peptic ulcer bleeding (PUB) have an excess long term all cause mortality compared with the general population free of PUB. Design-Follow up study of previously identified cohort of patients with a PUB episode and a general population cohort. Setting-The source population included all people aged 30 to 89 years, registered with general practitioners in the United Kingdom. Patients-All patients alive one month after the PUB episode constituted the cohort of PUB patients (n=978). A control group of 5000 people was randomly sampled from the source population. The same eligibility criteria as for patients with PUB were applied to the control series. Also, controls had to be free of PUB before start date. Main results-Relative risk of mortality among PUB patients was 2.1, 95%CI: 1.7, 2.6) compared with the general population. This increased mortality risk occurred mainly in the patients less than 60 years old. No diVerence was observed between men and women. The excess mortality was not only circumscribed to deaths attributable to recurrent gastrointestinal bleed, but also cardiovascular, cancer and other causes. Conclusions-People who have survived an acute episode of PUB have a reduced long term survival compared with the general population.This reduction was stronger among middle age patients than in the elderly.

Epidemiology of Upper Gastrointestinal Bleeding

“…10 However cause of death information was not available, and cause of death was imputed by the most recently recorded co-morbidity, increasing the risk of missclassification. An upper age limit also meant that the study's age distribution differed considerably from my unselected cohort, so it was no longer representative of those currently presenting with bleeds.…”

“…9 However both these studies were small, and the study by Ruigomez et al 10 did not have cause of death information but imputed the information from co-morbidity recorded prior to the bleed, and the study by Hudson et al 9 found an expected survival greater than 100% in controls and therefore used comparisons with national statistics in their analysis.…”

“…125 The only controlled studies of causes of death that have been done were in small bleeding peptic ulcer cohorts in the early 1990s, and these found mortality was CHAPTER 2: BACKGROUND: Causes of excess death elevated 2 fold for up to 5 years following a bleed, compared to the general population. 9,10,126 Much of this long term increase in mortality appeared related to co-morbidity, particularly cancer and cardiovascular disease 10 and up to 50%…”

“…9,10 However it is not known if this is caused by comorbidity or whether the upper gastrointestinal haemorrhage itself increases the mortality. If such bleeding is a marker of coexisting morbidity and an associated decline in health, then focusing resources on improving acute treatment may not improve mortality.…”

“…9,10 These showed an excess mortality unrelated to the bleeding event itself but the studies disagreed on which causes of death were increased. Other studies were not population based, 126 or were so long ago as to be mostly irrelevant with respect to current management of bleeding.…”