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: firstname.lastname@example.org
Received March 31, 2017
Accepted June 3, 2017