Peptic ulcer disease (PUD) requiring surgical treatment has become rare with the availability of modern medical management. A retrospective study of all patients who required operations for PUD between 1949 and 1994 (n = 43) was done. The patients were classified into 3 groups: A (n = 38): pre-histamine-2 (H2) blocker era (1949-1975); B (n = 3): pre-hydrogen-potassium (H-K+) ATPase inhibitor era (1976-1988); C (n = 2): H-K+ ATPase inhibitor era (1989-1994). Data, analyzed using X2 analysis (P .01). Children with PUD can have complications similar to those of adults with PUD. Since the introduction of H2 antagonists, the recognition and treatment of H pylori, and the use of H-K+ ATPase inhibition, the incidence of operations for bleeding and perforation has decreased dramatically. However, the incidence of surgery for obstruction remains the same.
BACKGROUND: The incidence of peptic ulcer disease was expected to decrease following the introduction of acid inhibitors and Helicobacter pylori eradication. AIM: To analyse possible changes in the incidence of bleeding peptic ulcer, treatment and mortality over time. METHODS: Residents of Malmö hospitalized for bleeding gastric or duodenal ulcer disease during 1987-2004 were identified in hospital databases (n = 1610). The material was divided into 6-year periods to identify changes over time. All patients who had been submitted to emergency surgery (n = 137) were reviewed. RESULTS: The incidence rate for bleeding gastric or duodenal ulcers decreased by one half in males and by one-third in females and emergency operations decreased significantly (9.2%, 7.5% and 5.7% during the three time periods, respectively (P
In a consecutive prospective series of 208 Swedish primary peptic ulcer patients, 146 gastric, 55 duodenal and 7 in both sites, gastroduodenitis was found in 97.6% of the cases. The mucosal inflammation was associated with CP in 87% and 91% of the gastric and duodenal ulcer cases respectively. No significant correlation was found between CP colonisation and the type or severity of mucosal inflammation. Gastric metaplasia was present in only 8% of 48 bulbar ulcer cases. Ulcer healing and eradication of CP was achieved in 52% of patients treated with bismuth subnitrate in combination with erythromycin or according to the triple approach.
In a consecutive prospective series of 186 Swedish persons with the diagnosis of non-ulcer dyspepsia 71.5% were found to have gastritis and/or bulbar duodenitis in endoscopic biopsies. Gastroduodenitis was associated with campylobacter pylori (CP) in 83.5% of the cases. The double therapeutic approach using an antibiotic and a preparation containing bismuth in an uncontrolled therapeutic pilot trial resulted in improvement of the histological picture, disappearance of CP and amelioration of symptoms. It is concluded that CP-infection plays a central role in the pathogenesis of gastroduodenitis associated NUD.
Three features of ulcer prevalence in Russia and therapeutic policy in ulcer consist of an increase of ulcerous patients number, a decrease of elective operations number for uncomplicated ulcers and an increase of emergency operations rate in complicate ulcer. Decrease of elective operations number leads to increase of emergency operations rate in complicated ulcer. The majority of complicated ulcers has long-term anamnesis, complications develop in chronic ulcers. Expansion of indications to elective operations in uncomplicated gastric and duodenal ulcer is advocated.
BACKGROUND: Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA). METHODS: All cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey. RESULTS: When comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p
To describe the use of anti-ulcer medication in the Quebec older population; to examine determinants of initiation, suboptimal use, and switches between products.
Population-based retrospective cohort study.
Universal health program for older adults in Quebec.
5000 users and 5000 non-users of anti-ulcer medications were selected randomly. Use was defined as the presence in the 1991 prescription database of an anti-ulcer prescription. Among users, 1697 (34%) were new users and were considered as the exposure group. Subjects were followed for 365 days after inclusion.
Measured were patient's age, gender, prescribed duration of anti-ulcer medication, concomitant medications, and gastrointestinal diagnostic procedures.
A total of 17% of new users had unusually short courses; 18% were long-term users. There was no difference in duration for omeprazole compared with other anti-ulcer medications. First-time use of NSAIDs was the strongest predictor of initiation of anti-ulcer medication (odds ratio = 3.21; 95% CI, 2.66-3.88). Twenty-six percent of users switched brands. Only 9.5% of new users underwent a diagnostic procedure before initiation of therapy, and 49% of long-term users ever underwent such procedure.
Despite a relatively homogeneous recommended duration of therapy, patterns of use of anti-ulcer medication among older people are highly variable, and treatment is often not accompanied by a diagnostic procedure.
This study aimed to compare use of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), 2001-2005, in the elderly and social security beneficiaries in Australia (AUS) and Nova Scotia, Canada (NS).
Prescription dispensing data were collected for all subsidised H2RAs and PPIs. In AUS, dispensing data for concession beneficiaries were obtained from the Pharmaceutical Benefits Scheme database. In NS, data were sourced from the Pharmacare database. Relevant population data were used to convert to World Health Organisation Anatomic Therapeutic Chemical defined daily doses (2005) per 1000 beneficiaries per day (DDD/1000/day).
Overall use of gastroprotective agents was similar and rising in NS and AUS (100-160?DDD/1000/day) over this 5-year time window. However, the proportion of this use accounted for by PPIs was far higher in AUS (over 85% by 2005) than in NS (23% rising to 35% over the 5?years). In AUS, PPI use rose from 50 to about 140?DDD/1000/day over the 5?years, whereas PPI use in NS rose slowly to less than 60?DDD/1000/day by 2005. H2RA use in NS was always high (over 100?DDD/1000/day), whereas in AUS, H2RA use fell from 54 to around 24?DDD/1000/day over this period.
AUS had much higher use of PPIs than NS over 2001-2005. The proportion of PPIs in all gastroprotective agents rose in AUS to be nearly 90%. The differences in utilisation during this time window could lead to differences in health outcomes from either lower gastro-intestinal bleeding risk or higher long-term adverse effects of PPIs.