Peptic Ulcer Bleeding Today: Risk Factors and Characteristics of the Disease

Abstract

This study was undertaken to ascertain whether the modern effective anti-ulcer drugs have had any influence on the natural history of hemorrhagic peptic ulcer disease and other acid-related gastroduodenal bleeding disorders. In the prospective part of the study the anamnestic data of all 73 patients admitted to our hospital with a bleeding ulcer or related disease during the year 1989 were compared with the data of 73 patients subjected to elective upper GI tract endoscopy for abdominal symptoms other than bleeding, paying special attention to potential risk factors. There were no differences in previous ulcer history or operations for ulcer disease between these two groups. Cigarette smoking and coffee consumption were not different, but the bleeders consumed alcohol more often, and, in particular, they used ulcerogenic drugs or other hemorrhagic diathesis-provoking agents significantly more frequently than controls. In the retrospective part of the study these 73 patients were compared with the medical records of all 87 patients admitted to our hospital in 1976 for a bleeding peptic ulcer disease, to ascertain whether introduction of H₂- blocking agents had had any influence on the nature of the patient population, characteristics of the disease, and severity of bleeding. The patients had become slightly older, and male preponderance was seen in both groups. The proportion of gastric ulcer had decreased, and duodenal ulcer had increased. In general, the bleeding seemed to become less severe but was more severe among women in both groups. In 1989 almost all patients were treated with H₂ antagonists, and seven patients received additional medical therapy (vasopressin, somatostatin, or tranexamic acid). The incidence of emergency operations was significantly decreased (from 36% in 1976 to 8% in 1989). According to this study, during the H₂-antagonist era known predisposing factors of peptic ulcer disease aside from ulcerogenic drugs do not play an important role in bleeding ulcer disease. Further, the patient population with a bleeding ulcer has not markedly changed during the H₂-antagonist era. Also, it is evident that today it is more often possible to control the hemorrhage from a peptic ulcer with conservative methods than 14 years ago.

Key Words:

• Bleeding peptic ulcer
• H₂ antagonists
• therapy
• ulcerogenic drugs