The influence of etiologic factors on clinical outcome in patients with peptic ulcer bleeding.
BACKGROUND
Peptic ulcer bleeding remains an important cause of morbidity and mortality.


OBJECTIVE
The aim of this study was to evaluate the prevalence of non-steroidal anti-inflammatory drugs (NSAID) use, Helicobacter pylori infection and non-H. pylori-non-NSAIDs causes of peptic ulcer bleeding and to identify the predictive factors influencing the rebleeding rate and in-hospital mortality in patients with bleeding peptic ulcer.


METHODS
A total of 1,530 patients with endoscopically confirmed peptic ulcer bleeding were evaluated consecutively between January 2005 and December 2009. The 30-day mortality and clinical outcome were related to patient's demographic data, endoscopic and clinical characteristics.


RESULTS
The age-standardized 1-year cumulative incidence for peptic ulcer bleeding was 40.4 cases/100,000 people. The proportion of patients over 65 years increased from 45.7 % in 2005 to 61.4 % in 2009 (p = 0.007). Overall 30-day mortality rate was 4.6 %, not significantly different for conservatively and surgically treated patients (4.9 vs. 4.1 %, p = 0.87). Mortality was significantly higher in patients over 65 years of age and those with in-hospital bleeding recurrence. Patients with non-H. pylori-non-NSAID idiopathic ulcers had significantly higher 30-day mortality rate than those with H. pylori ulcers and NSAID-H. pylori ulcers (7.1 vs. 0 vs. 0.8 %, p = 0.001 and p = 0.007, respectively). There was no statistically significant difference between patients with NSAID ulcers and non-H. pylori-non-NSAID idiopathic ulcers in terms of 30-day mortality rate (5.3 vs. 7.1 %, p = 0.445).


CONCLUSIONS
The incidence of peptic ulcer bleeding has not changed over a 5-year observational period. The overall 30-day mortality was positively correlated to older age, underlying comorbid illnesses, in-hospital bleeding recurrence and the absence of H. pylori infection.
Division of Gastroenterology, Department of Internal Medicine, Medical and Dental Faculty, Sestre Milosrdnice University Hospital Center, University of Zagreb, Vinogradska 29, 10000, Zagreb, Croatia. neven.ljubicic@zg.t-com.hr
Neven
N
Ljubičić
Zeljko
Z
Puljiz
Ivan
I
Budimir
Alen
A
Bišćanin
Andre
A
Bratanić
Tajana
T
Pavić
Marko
M
Nikolić
Davor
D
Hrabar
Vladimir
V
Supanc
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D016099:Endoscopy, Gastrointestinal; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000150:complications / Q000209:etiology; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal