Bleeding peptic ulcers becoming much less common in Sweden

MedWire News: The number of people who are hospitalized with bleeding peptic ulcers has fallen by up to half since the 1980s, a Swedish study indicates.

Since the identification of Helicobacter pylori and the introduction of potent acid inhibitors there has been a marked decrease in the incidence of peptic ulcer disease and in elective surgery. But trends in peptic ulcer mortality are contradictory and little is known about changes in rates of bleeding ulcer disease.

To investigate, Gert Lindell (Mälmo University Hospital) and colleagues used hospital databases to identify all residents of Mälmo who were hospitalized between 1987 and 2004 for a bleeding gastric or duodenal ulcer.

A total of 1610 such individuals were identified, 137 of whom required emergency surgery, report Lindell and team in the journal Alimentary Pharmacology and Therapeutics.

The incidence rate for bleeding peptic ulcer decreased markedly during the 18-year study period. In men, the decrease was 64% for duodenal ulcer and 54% for gastric ulcer; in women, the corresponding reductions were 37% and 35%.

Decreases were apparent in all age groups, the authors observe, but were particularly striking in the youngest age group (25–44 years) and less pronounced in women aged 75 years and above.

The incidence rate of emergency surgery also fell over time, from 9.2% in the first 6 years of the study to 5.7% in the last 6 years. The proportion of gastric resections also fell over time, in favor of more limited surgical procedures, whereas endoscopic treatment became increasingly common.

Mortality associated with bleeding ulcers was unchanged, at less than 4%, throughout the study period.

Lindell and colleagues believe that the gradual eradication of H. pylori together with a change in smoking habits could explain the reduction in bleeding ulcers over the last 2 decades.

Interestingly, they add: “These findings could not be explained by aspirin/non-steroidal anti-inflammatory drug consumption patterns as intake increased both over time and with age, more so in men.”