[Hemorrhaging eso-gastro-duodenal ulcers: epidemiology and management. A multicenter prospective study].
The aim of this study was to estimate the incidence, and to describe the characteristics and medical care in patients with bleeding upper gastrointestinal ulcers in the general population.


METHODS
A study was performed over six months in 1996 in 4 French geographical areas: Finistère, Gironde, Seine-Maritime, and the Somme (3 million people minimum 18 years). All public or private hospitals, and specialist gastroenterologists in private practice participated in the study, based on a standardized questionnaire.


RESULTS
Over 6 months 793 patients with bleeding ulcers were identified, corresponding to 27 per 100,000 inh./year or 24,000 cases in France. Most patients were men (60%) and 40.1% were 75 years and older. The ulcer was oesophageal (6%), gastric (47%), or duodenal (69%). In 406 patients (51.2%) a chronic disease was present (cancer, cirrhosis, circulatory, respiratory or cardiac disease). In 237 cases (29.9%) the ulcer occurred in patients, 453 patients (57.1%) were admitted and 103 patients (13%) were managed as outpatients. Gastrotoxic drugs were taken by 349 patients (44%): non steroidal anti-inflammatory drugs (18.7%), aspirin (21.2%, including 2/3 with doses under 330 mg/day), corticosteroids (7.8%) and 24.3% had anticoagulant therapy. Patients were managed in university hospitals (39.3%), other public or non profit hospitals (44.2%) or private hospital (16.5%) with geographical differences between the 4 areas. Therapeutic endoscopy was performed in 16.9% and a surgical procedure was performed in 5.9%. The mortality rate (outpatients excluded) was 13.5% (n = 93), but only 2% (n = 16) of death were associated with a bleeding ulcer: mortality was higher in inpatients (24.1%) than in out patients (8.1%). A chronic disease was also associated with higher mortality (17.9% versus 8.1%).


CONCLUSIONS
Bleeding ulcers are frequent and severe, especially in inpatients or associated with chronic conditions. A gastrotoxic drug used is found in about fifty percent of the cases.
Nousbaum
J B
JB
Service d'hépato-gastroentérologie, CHU La Cavale Blanche, Brest.
Hochain
P
P
Kerjean
A
A
Rudelli
A
A
Lalaude
O
O
Herman
H
H
Czernichow
P
P
Dupas
J L
JL
Amouretti
M
M
Gouerou
H
H
Colin
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004381:Duodenal Ulcer / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D004935:Esophageal Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D014456:Ulcer / Q000150:complications / Q000453:epidemiology* / Q000601:surgery