Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects

Abstract

Background: Although overall admission rates for peptic ulcer in England declined from the 1950s up until the mid 1980s, perforations among older women increased, possibly due to increasing use of non-steroidal anti-inflammatory drugs (NSAID). Since then, proton pump inhibitors, antibiotic treatment for Helicobacter pylori, low dose aspirin, and selective serotonin reuptake inhibitors (SSRI) have been introduced Aims: To determine time trends for hospital admissions for peptic ulcer from 1989 to 1999 (England), mortality from 1958 to 1998 (England and Wales), and prescriptions for ulcer healing drugs, aspirin, NSAID, oral anticoagulants, and SSRI from 1990 to 1999 (England). Methods: Hospital episode statistics for admissions and mortality were obtained from the Office of National Statistics: community prescription data from Statistics Division 1E of the Department of Health. Results: Between 1989/90 and 1998/99, there was a marked rise in admissions for haemorrhage in older patients, particularly from duodenal ulcer. Perforations from gastric ulcer declined but perforations from duodenal ulcer increased among men at older ages. Since the mid 1980s mortality has declined in all age groups except for older women with duodenal ulcer. The number of prescriptions for histamine H 2 receptor antagonists remained constant but those for proton pump inhibitors increased by 5000%, aspirin 75mg by 460%, oral anticoagulants by 200%, and NSAID by 13% between 1990 and1999. Since the introduction of SSRI in 1991, prescriptions have increased 15-fold. Conclusions: Admission rates for gastric and duodenal ulcer haemorrhage and duodenal ulcer, but not gastric ulcer perforation, increased among older subjects, over a time when prescriptions for proton pump inhibitors, low dose aspirin, oral anticoagulants, and SSRI increased.

Upper Gastrointestinal Endoscopy in Patients Aged 65 Years or Older: Indications and Main Findings From a Referral Hospital, Jazan, Saudi Arabia

“…In previous studies, 35%-65.2% of all patients who presented with acute upper GI bleeding were aged over 60 years. [16][17][18] Epigastric pain was the indication for upper GI endoscopy in 11.3% of our patients, a very low figure compared with previous studies of elderly populations. 9,19 The very low rate may be attributed to differences in definitions and methodologies between the different studies.…”

Epidemiology of Upper Gastrointestinal Bleeding

“…[3][4][5] Although the overall incidence of gastro-duodenal ulcer bleeding has remained stable during the 1990s, in the elderly it increased by over 30%. 6,7 It is likely that this increase is related to higher rates of co-morbidities, increased prescriptions for these co-morbidities and interactions between the two. However outside of critical care, where primary prevention for stress ulceration is routinely prescribed, peptic ulceration is not thought to be related to co-morbidities.…”

Management of Peptic Ulcer Perforation is there A Role for Conservative Management? A Research Study at a Tertiary Care Center in North East India

“…This may be due to an increase in use of Non-steroidal anti-inflammatory drugs and lifestyle changes such as smoking and alcohol consumption [3,4] .…”