Epidemiology and adherence to guidelines on the management of bleeding peptic ulcer: a prospective multicenter observational study in 1140 patients.
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.
Department of gastroenterology, Henri-Mondor-hospital, 51, avenue du Maréchal-de-Lattre, 94010 Créteil, France. jdzeitoun@yahoo.fr
Jean-David
JD
Zeitoun
Isabelle
I
Rosa-Hézode
Ariane
A
Chryssostalis
Bernard
B
Nalet
Bruno
B
Bour
Jean-Pierre
JP
Arpurt
Jacques
J
Denis
Stéphane
S
Nahon
Alexandre
A
Pariente
Hervé
H
Hagège
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012008:Recurrence; D013927:Thrombosis / Q000453:epidemiology / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors; D014662:Vasoconstrictor Agents; D004837:Epinephrine