Mortality from peptic ulcer bleeding: impact of co-morbidity and use of bleeding promoting drugs.

International audience ; Background: Use of drugs promoting peptic ulcer bleed (PUB) have increased several fold. Aim: To make a time-trend analysis of PUB patients and evaluate the impact of age, gender, co-morbidity and use of drugs promoting PUB on outcome. Methods: Retrospective review of hospitalisations for PUB at Lund University Hospital 1984, 1994 and 2004. Univariate analyses between years and multivariable logistic regression for risk factors of fatal outcome. Results: Incidence decreased from 62.0 to 32.1 per 100,000 inhabitants between 1984 and 2004. Mortality rates were stable. Median age (70 to 77 years (p=0.001)), number of co-morbidities ((mean+/-SD) 0.88+/-0.96 to 1.16+/-0.77 (p=0.021)), use of aspirin (16 to 57% (p<0.001)) and warfarin (5 to 17% (p=0.02)) increased. Pharmacological and endoscopic therapy improved. Age above 65 years (OR:1.11, 95%CI:1.02-1.23) and number of co-morbidities (OR:6.00, 95%CI:2.56-17.4) were independent risk factors for in-hospital mortality. Bleeding promoting drugs did not influence outcome negatively. Aspirin decreased the risk of fatal outcome (OR:0.12, 95%CI:0.012-0.67). Conclusion: Incidence of PUB decreased despite higher prescription rates of bleeding promoting drugs. In-hospital mortality was unchanged. The effect of improved therapy against PUB is probably outweighed by older and more co-morbid patients. The decreased risk of fatal outcome in aspirin users warrants further investigations.