title: One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable.
abstract: OBJECTIVE
  To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).
  
  
  METHODS
  Retrospective cohort study using ICD-10 codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD, EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne, Australia. Patients were divided into "high risk" (those who would benefit from gastroprotection) and "not high risk" groups as defined by established guidelines. Mean Rockall score, transfusion requirement, length of stay, rebleeding rates, need for surgery and in-hospital mortality was compared between "high risk" and "not high risk" groups. Within the "high risk" group, those on gastroprotection and those with no gastroprotection were also compared.
  
  
  RESULTS
  Five hundred and seven patients were included for analysis of which 174 were classified as high risk. Median values of complete Rockall Score (5 vs 4, P = 0.002) and length of stay (5 d vs 4 d, P = 0.04) were higher in the high risk group but in-hospital mortality was lower (0.6% vs 3.9%, P = 0.03). 130 out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization. Past history of PUD (OR = 3.7, P = 0.006) and clopidogrel use (OR = 3.2, P = 0.007) significantly predicted prescription of gastroprotective therapy. Using proton pump inhibitor protection rates of 50%-85% from published studies, an estimation of 13% to 22% of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.
  
  
  CONCLUSIONS
  Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Ray
authors.initials: R
authors.lastname: Boyapati
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Sim Ye
authors.initials: SY
authors.lastname: Ong
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Bei
authors.initials: B
authors.lastname: Ye
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Anuk
authors.initials: A
authors.lastname: Kruavit
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Nora
authors.initials: N
authors.lastname: Lee
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Rhys
authors.initials: R
authors.lastname: Vaughan
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Nandurkar
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia.
authors.forename: Mayur
authors.initials: M
authors.lastname: Garg
mesh_terms: D016009:Chi-Square Distribution; D004382:Duodenitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014739:Victoria
chemical_list: D054328:Proton Pump Inhibitors
keywords: Gastrointestinal hemorrhage; Gastroprotection; Non-steroidal anti-inflammatory drug; Peptic ulcer; Prevention; Proton pump inhibitor