Epidemiology and adherence to guidelines on the management of bleeding peptic ulcer: A prospective multicenter observational study in 1140 patients

• Published in: Clinics and research in hepatology and gastroenterology Vol. 36; no. 3; pp. 227 - 234
• Main Authors: Zeitoun, Jean-David, Rosa-Hézode, Isabelle, Chryssostalis, Ariane, Nalet, Bernard, Bour, Bruno, Arpurt, Jean-Pierre, Denis, Jacques, Nahon, Stéphane, Pariente, Alexandre, Hagège, Hervé
• Format: Journal Article
• Language: English
• Published: Issy-les-Moulineaux Elsevier Masson 01-06-2012
• Subjects: Aged; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Endoscopy, Gastrointestinal; Epinephrine - therapeutic use; Female; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Guideline Adherence; Helicobacter Infections - epidemiology; Helicobacter pylori; Humans; Internal Medicine; Male; Medical sciences; Other diseases. Semiology; Peptic Ulcer Hemorrhage - epidemiology; Peptic Ulcer Hemorrhage - therapy; Practice Guidelines as Topic; Prospective Studies; Proton Pump Inhibitors - adverse effects; Recurrence; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Thrombosis - epidemiology; Thrombosis - therapy; Vasoconstrictor Agents - therapeutic use; ANGH; Association Nationale des Gastroentérologues des Hôpitaux Généraux; NSAID; PPI; non-steroidal anti-inflammatory drugs; UGIB; proton pump inhibitor; upper gastrointestinal bleeding; Human; Gastroduodenal; Gastroenterology; Peptic ulcer; Digestive diseases; Intestinal disease; Epidemiology; Hemorrhage; Gastric disease
• ISSN: 2210-7401; 2210-741X
• DOI: 10.1016/j.clinre.2011.11.008

Summary Background and objective Mortality of upper gastrointestinal bleeding seems declining. Whether practice guidelines for the management of peptic ulcer bleeding are followed is unknown. We aimed to update epidemiology of peptic ulcer bleeding and to assess the adherence to guidelines in the French community. Methods Between March, 2005 and February, 2006, a prospective multicenter study was conducted including all patients with communautary upper gastrointestinal bleeding. Data from patients with peptic ulcer bleeding were extracted and analyzed. Results Out of 3203 analyzable patients included, 1140 (35.6%) had a peptic ulcer bleeding and 965 of them a duodenal and/or gastric ulcer. Seven hundred and thirty-five were male (64.5%) and mean age was 66.4 years (±18.8). Overall, 699 patients (61.3%) were taking medication inducing upper gastrointestinal bleeding. Two-hundred and sixty-eight (23.5%) patients had endoscopic therapy, 190 (70.9%) of whom had epinephrine injection alone. Among the 349 patients with high risk stigmata on endoscopy (Forrest IA, IB, IIA), 209 (59.9%) underwent endoscopic therapy. One thousand one hundred and seven patients (97.1%) were given proton-pump inhibitors. One hundred and thirty-four patients (11.8%) experienced haemorrhagic recurrence. Forty-eight patients (4.2%) underwent surgery and 61 (5.4%) died. Conclusions Consistently with previous studies, mortality of upper gastrointestinal bleeding seems declining. Further progress lies above all in prevention but also probably in better adherence to therapeutic guidelines and management of comorbidities.