title: Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan.
abstract: OBJECTIVE
  Proton pump inhibitors (PPI) have been rarely used for prevention of upper gastrointestinal bleeding (UGIB) induced by non-steroidal anti-inflammatory drugs (NSAIDs) and/or aspirin in Japan. The increased incidence of UGIB in the aged society is becoming a serious problem. The aim of this study was to retrospectively evaluate whether PPI can prevent UGIB.
  
  
  METHODS
  We examined records of 2367 patients (aged 67.9 ± 15.1 years, male 1271) attending the only hospital serving the rural area, with little population movement. We investigated the correlation between the frequency of usage of medicine (PPI, histamine 2 receptor antagonists [H2RA], NSAIDs, aspirin) and incidence of UGIB over 12 years. UGIB was defined as cases with hematemesis and/or melena and definite bleeding at upper gastrointestinal endoscopy. The annual incidence of UGIB of inhabitants (16,065 ± 375.3 persons/year) was evaluated. The frequency of usage of medicine was compared with the total number of patients prescribed any medication (1080 ± 33.2 persons/year).
  
  
  RESULTS
  The frequency of PPI usage has increased significantly 4.6%→30.8% (P < 0.05). NSAIDs and aspirin usage increased significantly in the latter half of the survey period (P < 0.05). The annual incidence of UGIB significantly decreased 160.8 →23.6/100,000 inhabitants per annum (P ≤ 0.05) due to widespread use of PPI. No patients died due to UGIB after 2006. The incidence of UGIB and the prevalence of PPI usage were found to have a negative correlation (r = -0.804, P = 0.0016).
  
  
  CONCLUSIONS
  By widespread use of PPI, UGIB and related death has declined significantly. This survey showed that continuous PPI treatment decreases UGIB and related death in community medicine.
authors.affiliation: Department of General Internal Medicine, Prefectural Hiroshima Hospital, Hiroshima, Japan. mykmiya@f2.dion.ne.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Miyamoto
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamoto
authors.forename: Yuusuke
authors.initials: Y
authors.lastname: Higashi
authors.forename: Toru
authors.initials: T
authors.lastname: Hidaka
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D004334:Drug Administration Schedule; D004363:Drug Utilization; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000401:mortality / Q000517:prevention & control*; D006396:Hematemesis / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008551:Melena / Q000139:chemically induced / Q000517:prevention & control; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors