Time trends in incidence of peptic ulcer bleeding and associated risk factors in Norway 1985–2008

Figures & data

Table 1 Number of patients/population (incidencea) and age-adjusted incidence of peptic ulcer bleeding in a defined geographical area in Norway during the time periods 1985–1986, 1995–1996, and 2007–2008

Time period	1985–1986	1995–1996	2007–2008	Pvalue
Age (years)
≥20 ≤75	66/60726 (54)^Citation1	69/63384 (54)	36/71096 (25)^Citation2	0.001 (1 vs 2)
<75	33/6060 (272)^Citation1	39/6503 (300)	63/7754 (406)^Citation2	0.0001 (1 vs 2)
Total	101b/96674 (52)a	108/99294 (54)	99/109240 (45)	NS

Notes:

a cases/100,000/year;

b two patients younger than 20 years (16 and 18 years) were included in 1985–1986.

Abbreviation: NS, not significant.

Table 2 Demographics, ulcer history, dyspepsia and hematemesis in patients admitted for peptic ulcer bleeding in the time periods 1985–1986, 1995–1996, and 2007–2008

	1985–1986	1995–1996	2007–2008	Pvalue
Patients (n)	99	108	99
Male/female	49/50	67/41	54/45	NS
Mean age (95% CI)	63 (59–66)	69 (65–73)	74 (70–78)
Previous ulcer	47 (47)	44 (41)	32 (32)	NS
Previous bleeding ulcer	25 (25)	16 (15)	13 (13)	NS
Previous perforated ulcer	4 (4)	1 (0.9)	3 (3)	NS
Dyspepsia	59 (60)^a	48 (44)^b	12 (12)^c	0.0000–0.0002 (a, b, vs c)
Hematemesis	42 (42)	44 (41)	39 (39)	NS

Abbreviations: CI, confidence interval; NS, not significant.

Table 3 Oral use of aspirin or NSAIDs, drugs which may be related to bleeding, alcohol, tobacco, and Helicobacter pylori

	1985–1986	1995–1996	2007–2008	Pvalue
	n = 99	n = 108	n = 99
High-dose aspirin1	18 (18)^a	8 (7)^b	1 (1)^c	0.0001 (a vs c)
Low-dose aspirin2	1 (1)^a	12 (11)^b	37 (37)^c	0.007–0.0000
NSAIDs3	12 (12)^a	24 (22)^b	42 (42)^c	0.03–0.0003 (a, b, vs c)
Aspirin or NSAIDs	31 (31)^a	42 (39)^b	66 (67)^c	0.004–0.03 (a, b, vs c)
Aspirin or NSAIDs
20–75years	20/66 (30)^a	22/69 (32)^b	22/36 (61)^c	0.06 (a vs c)
> 75 years	11/33 (33)^a	20/39 (51)^b	44/63 (70)^c	0.06 (a vs c)
Warfarin	0^a	4 (4)^b	18 (18)^c	0.0000–0.002 (a, b vs c)
Steroids	1 (1)^a	9 (8)^b	12 (12)^c	0.02–0.003 (a vs b, c)
Alcohol	8 (8)	6 (6)	7 (7)	NS
Tobacco	27 (27)	21 (19)	15 (15)	NS
H. pylori tested		87 (81)	75 (76)	NS
H. pylori positive		73 (84)	39 (52)	0.06
H. pylori positive
Duodenal ulcer		51/62 (82)	27/47 (57)	NS
Gastric ulcer		22/25 (88)	12/28 (43)	NS
H. pylori positive
Aspirin or NSAID users		22/30 (73)	28/55 (51)	NS
Nonusers		51/57 (89)	11/20 (55)	NS

Notes:

1 Aspirin 0.5–1g;

2 Aspirin 75–160 mg;

1,2,3 Patients with simultaneous use of aspirin and NSAID are recorded twice.

Abbreviations: NS, not significant; NSAID, nonsteroidal anti-inflammatory drug.

Table 4 Findings at the index endoscopy related to oral use or nonuse of aspirin or NSAIDs

	1985–1986	1995–1996	2007–2008	Pvalue
	n = 99	n = 108	n = 99
Duodenal ulcer	52 (53)	72 (67)	58 (59)
Gastric ulcer	47 (47)	36 (33)	41 (41)
DU/GU ratio	1.1	2	1.4	NS
Aspirin or NSAID users
Duodenal ulcer	12 (23)^a	24 (33)^b	36 (62)^c	0.01–0.06 (a, b vs c)
Gastric ulcer	19 (40)	18 (50)	30 (73)	NS
DU/GU ratio (users)	0.6	1.3	1.2
Aspirin or NSAID nonusers
Duodenal ulcer	40 (77)^a	48 (67)^b	22 (38)^c	0.03–0.07 (a, b vs c)
Gastric ulcer	28 (60)^a	18 (50)^b	11 (27)^c	0.07 (a vs c)
DU/GU ratio (nonusers)	1.4	2.7	2
Ulcer size >2 cm	23 (23)	30 (28)	23 (23)	NS
Bleeding activity (Forrest)
Arterial (F 1a)	4 (4)	5 (5)	5 (5)	NS
Oozing (F 1b)	15 (15)	10 (9)	18 (18)	NS
Visible vessel (F 2a)	2 (2)	3 (3)	7 (7)	NS
Clot (F 2b)	9 (9)	5 (4)^b	16 (16)^c	0.02 (b vs c)
Black spot (F 2c)	2 (2)^a	14 (13)^b	26 (26)^c	0.007–0.0000 (a vs b, c)
No signs (F 3)	67 (68)^a	71 (66)^b	27 (27)^c	0.0006–0.0008 (a, b vs c)

Abbreviations: DU, duodenal ulcer; GU, gastric ulcer; NSAID, nonsteroidal anti-inflammatory drug.

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