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Outcomes of patients hospitalized with peptic ulcer disease diagnosed in acute upper endoscopy

Malmi, Hannaa; Kautiainen, Hannub,d; Virta, Lauri J.e; Färkkilä, Martti A.c

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1251–1257
doi: 10.1097/MEG.0000000000000951
Original Articles: Gastro-esophageal Disorders

Objectives: The incidence and complications of peptic ulcer disease (PUD) have declined, but mortality from bleeding ulcers has remained unchanged. The aims of the current study were to evaluate the significance of PUD among patients admitted for acute upper endoscopy and to evaluate the survival of PUD patients.

Patients and methods: In this prospective, observational cohort study, data on 1580 acute upper endoscopy cases during 2012–2014 were collected. A total of 649 patients were included with written informed consent. Data on patients’ characteristics, living habits, comorbidities, drug use, endoscopy and short-term and long-term survival were collected.

Results: Of all patients admitted for endoscopy, 147/649 (23%) had PUD with the main symptom of melena. Of these PUD patients, 35% had major stigmata of bleeding (Forrest Ia–IIb) in endoscopy. Patients with major stigmata had significantly more often renal insufficiency, lower level of blood pressure with tachycardia and lower level of haemoglobin, platelets and ratio of thromboplastin time. No differences in drug use, Charlson comorbidity class, BMI, smoking or alcohol use were found. Of the PUD patients, 31% were Helicobacter pylori positive. The 30-day mortality was 0.7% (95% confidence interval: 0.01–4.7), 1-year mortality was 12.9% (8.4–19.5) and the 2-year mortality was 19.4% (13.8–26.8), with no difference according to major or minor stigmata of bleeding. Comorbidity (Charlson>1) was associated with decreased survival (P=0.029) and obesity (BMI≥30) was associated with better survival (P=0.023).

Conclusion: PUD is still the most common cause for acute upper endoscopy with very low short-term mortality. Comorbidity, but not the stigmata of bleeding, was associated with decreased long-term survival.

aDepartment of Gastroenterological Surgery

bDepartment of General Practice, Unit of Primary Health Care

cClinic of Gastroenterology, Helsinki University Hospital, Helsinki University, Helsinki

dPrimary Health Care Unit, Kuopio University, Kuopio

eResearch Department, The Social Insurance Institution of Finland, Turku, Finland

Correspondence to Hanna Malmi, MD, Department of Gastrointestinal Surgery, Abdominal Center, Helsinki University Hospital, Helsinki University, PL 800, Helsinki, 00029 HUS, Finland Tel: +358 9 4711; fax: +358 9471 7468; e-mail: hanna.malmi@helsinki.fi

Received March 31, 2017

Accepted June 3, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.