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

• Published in: Gut Vol. 50; no. 4; pp. 460 - 464
• Main Authors: Higham, J, Kang, J-Y, Majeed, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.04.2002; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; Copyright 2002 by Gut
• Subjects: Adult; Age Distribution; Aged; Analysis; aspirin; Biological and medical sciences; Demographic aspects; Drug Prescriptions - statistics & numerical data; duodenal ulcer; Duodenal Ulcer - mortality; Duodenal Ulcer - surgery; England - epidemiology; Female; gastric ulcer; Gastroenterology. Liver. Pancreas. Abdomen; Histamine H2 Antagonists - therapeutic use; Hospital utilization; Hospitalization - statistics & numerical data; Hospitalization - trends; Humans; Length of stay; Male; Medical sciences; Middle Aged; Mortality; non-steroidal anti-inflammatory drugs; NSAID; Other diseases. Semiology; Patient admissions; Peptic Ulcer; peptic ulcer haemorrhage; Peptic Ulcer Hemorrhage - mortality; Peptic Ulcer Hemorrhage - surgery; peptic ulcer perforation; Peptic Ulcer Perforation - mortality; Peptic Ulcer Perforation - surgery; Prescription drugs; Prevalence studies (Epidemiology); Proton Pump Inhibitors; serotonin reuptake inhibitors; Sex Distribution; SSRI; Stomach Ulcer - mortality; Stomach Ulcer - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Survival Rate; Ulcers; Vagotomy - statistics & numerical data; Womens health; England; United Kingdom; United Kingdom > UK; Consumption; Human; Pathogenesis; Perforation; Cardiovascular disease; Gastrointestinal; Epidemiology; Hemorrhage; Vascular disease; Non steroidal antiinflammatory agent; Gastroduodenal; Digestive diseases; Intestinal disease; Complication; Ulcer; Gastric disease
• ISSN: 0017-5749; 1468-3288; 1468-3288; 1458-3288
• DOI: 10.1136/gut.50.4.460

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 H2 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 and 1999. 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.