title: Esophageal Ulcer as a Cause of Death: A Population-Based Study. Mortality of Esophageal Ulcer Disease.
abstract: BACKGROUND
  This study aimed at defining the mortality and the nature of fatal complications that arise out of esophageal ulcer for one clearly defined geographical area.
  
  
  METHODS
  In this national, population-based study, the occurrence of fatal esophageal ulcer or ulcer requiring hospital treatment between January 1987 and December 2000 was assessed by the use of Finland's administrative databases. Medical records provided etiology of fatal ulcer and agonal symptoms.
  
  
  RESULTS
  Due to an esophageal ulcer, 2,242 patients received treatment in Finnish hospitals, at an annual frequency of 3.2/100,000. Ulcer with hemorrhage (53.5%), perforation (38.4%), or aspiration pneumonia (2.3%) was the cause of death in 86 patients for an annual mortality of 0.12/100,000. Based on the number of ulcers treated, 3.8% cases ended fatally. Gastroesophageal reflux disease (GERD) seemed to be the etiologic factor for ulcer in 68 (79.0%) patients. The most common agonal symptoms were hematemesis (41.8%), abdominal pain (25.6%), melaena (22.1%), and dyspnea (17.4%). Twenty (23.3%) patients were found dead at home.
  
  
  CONCLUSIONS
  The rarity of the disease, related disorders, and the diversity of symptoms make the complicated esophageal ulcer a diagnostic challenge. Effective monitored treatment for severe GERD may be an important step to prevent fatal outcome.
authors.affiliation: Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tuomo K
authors.initials: TK
authors.lastname: Rantanen
authors.forename: Eero I T
authors.initials: EI
authors.lastname: Sihvo
authors.forename: Jari V
authors.initials: JV
authors.lastname: Räsänen
authors.forename: Marja
authors.initials: M
authors.lastname: Hynninen
authors.forename: Jarmo A
authors.initials: JA
authors.lastname: Salo
mesh_terms: D015746:Abdominal Pain / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D004417:Dyspnea / Q000150:complications; D004935:Esophageal Diseases / Q000150:complications / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000150:complications; D006396:Hematemesis / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008551:Melena / Q000150:complications; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000401:mortality*; D014456:Ulcer / Q000150:complications / Q000401:mortality*; D055815:Young Adult