The Influence of Etiologic Factors on Clinical Outcome in Patients with Peptic Ulcer Bleeding

• Published in: Digestive diseases and sciences Vol. 57; no. 12; pp. 3195 - 3204
• Main Authors: LJubičić, Neven, Puljiz, Željko, Budimir, Ivan, Bišćanin, Alen, Bratanić, Andre, Pavić, Tajana, Nikolić, Marko, Hrabar, Davor, Supanc, Vladimir
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.12.2012; Springer; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Aging; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biochemistry; Care and treatment; Clinical outcomes; Clopidogrel; Endoscopy, Gastrointestinal; Gastroenterology; Helicobacter infections; Helicobacter Infections - complications; Helicobacter pylori; Hepatology; Humans; Infection; Medicine; Medicine & Public Health; Middle Aged; Mortality; Odds Ratio; Oncology; Original Article; Patient outcomes; Peptic ulcer; Peptic Ulcer - complications; Peptic Ulcer - etiology; Peptic Ulcer Hemorrhage - etiology; Peptic Ulcer Hemorrhage - mortality; Pneumoviridae; Risk Factors; Transplant Surgery; Peptic ulcer; Clinical outcome; Non-steroidal anti-inflammatory drugs (NSAIDs); Bleeding
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-012-2273-6

Background Peptic ulcer bleeding remains an important cause of morbidity and mortality. Aim The aim of this study was to evaluate the prevalence of non-steroidal anti-inflammatory drugs (NSAID) use, Helicobacter pylori infection and non- H. pylori –non-NSAIDs causes of peptic ulcer bleeding and to identify the predictive factors influencing the rebleeding rate and in-hospital mortality in patients with bleeding peptic ulcer. Methods A total of 1,530 patients with endoscopically confirmed peptic ulcer bleeding were evaluated consecutively between January 2005 and December 2009. The 30-day mortality and clinical outcome were related to patient’s demographic data, endoscopic and clinical characteristics. Results The age-standardized 1-year cumulative incidence for peptic ulcer bleeding was 40.4 cases/100,000 people. The proportion of patients over 65 years increased from 45.7 % in 2005 to 61.4 % in 2009 ( p  = 0.007). Overall 30-day mortality rate was 4.6 %, not significantly different for conservatively and surgically treated patients (4.9 vs. 4.1 %, p  = 0.87). Mortality was significantly higher in patients over 65 years of age and those with in-hospital bleeding recurrence. Patients with non- H. pylori –non-NSAID idiopathic ulcers had significantly higher 30-day mortality rate than those with H. pylori ulcers and NSAID– H. pylori ulcers (7.1 vs. 0 vs. 0.8 %, p  = 0.001 and p  = 0.007, respectively). There was no statistically significant difference between patients with NSAID ulcers and non- H. pylori –non-NSAID idiopathic ulcers in terms of 30-day mortality rate (5.3 vs. 7.1 %, p  = 0.445). Conclusion The incidence of peptic ulcer bleeding has not changed over a 5-year observational period. The overall 30-day mortality was positively correlated to older age, underlying comorbid illnesses, in-hospital bleeding recurrence and the absence of H. pylori infection.