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Rising rates of bleeding from ulcers in last decade despite changes in treatment

March 11, 2002

Hospital admissions for bleeding ulcers rose throughout the 1990s despite changes in drug treatment, reveals a study in Gut.

The researchers looked at the numbers of hospital admissions and deaths in England attributable to peptic ulcers from 1989 and 1998. They also looked at the number of prescriptions for ulcer healing drugs and those associated with an increased risk of gastrointestinal bleeding. These included new generation antidepressants (SSRIs), aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), and blood thinners.

The results showed that deaths from peptic ulcers continued to fall across all age groups except among women over the age of 65 in whom they stabilised. Admission rates for bleeding peptic ulcers among young people also continued to fall. But rates among the elderly of both sexes rose, particularly for duodenal ulcers.

For those aged 74 and upwards, admissions for peptic and gastric ulcers rose by 29 per cent in women and 40 per cent in men, with similar increases in admissions for gastrointestinal bleeding. For duodenal ulcers, admissions rose by a third among elderly women and almost doubled (49%) among men. Internal bleeding accounted for most of this. Among those aged between 64 and 74, rates again almost doubled, increasing by 48 per cent among women and 45 per cent among men.

Prescriptions for aspirin rose 460 per cent, for blood thinners (anticoagulants) by 200 per cent, and NSAIDs by 13 per cent. But prescriptions for the newer and more expensive ulcer healing drugs, proton pump inhibitors, rose by over 5000 per cent. By the end of the 1990s, 15 times as many SSRIs were being prescribed as when they were first introduced.

Further work is needed to look at prescribing patterns in terms of drug combinations, and the types of drugs given to older patients, say the authors.

British Medical Journal (BMJ)

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