Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002

Abstract

BackgroundDespite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA).MethodsAll cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey.ResultsWhen comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p < 0.001). Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 2002. The number of prescribed sales to women was higher than to males. Sales of low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the counter sale and sold on prescription, increased by 28% during the same period.ConclusionWhen comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.

Results of Surgery for Perforated Gastroduodenal Ulcers in a Dutch Population

“…Although the safety and efficacy of the laparoscopic approach has been sufficiently proven, its incorporation into daily practice remains low. This might be due to the fact that surgery for perforated gastroduodenal ulcers is still declining due to increasing use of H 2 -receptor antagonists and proton pump inhibitors as well as H. pylori eradication [30,31,32]. Therefore, we postulate that the low rate of laparoscopy in our series might be due to decreasing experience with this type of surgery overall.…”

The changing face of hospitalisation due to gastrointestinal bleeding and perforation

“…The reasons for these discrepancies are unclear, as a decrease of Helicobacter pylori (H. pylori) infection among the population, increasing H. pylori eradication therapy and increasing PPI use across Europe should be accompanied by a progressive decrease in peptic ulcer complications. 14,15,17 The variability in the use of low-dose aspirin (ASA) and gastro-protective Mean comparison among categories: P-value < 0.001.…”

“…7,8 Our data also show very low rates of mortality due to peptic ulcer bleeding, which is consistent with other studies. 8,14,15 The lack of improvement in case fatality rates is usually linked to a progressively ageing population with increasing numbers of co-morbidities, despite data that show better bleeding management strategies associated with reduction in the risk of rebleeding and a reduced need for surgery. 20 In any case, our data agree with a recent USA report 8 that shows an overall decrease (absolute numbers) in in-hospital deaths linked to GI bleeding diagnoses between 1998 and 2006, because of a decrease in the number of hospitalisations.…”

Use of non-steroidal anti-inflammatory drugs and proton pump inhibitors in correlation with incidence, recurrence and death of peptic ulcer bleeding: an ecological study

“…A previous study reported that the sales of NSAIDs in Sweden increased during the period 1978-2002. 11 The present study shows that sales have decreased since 2004 with regard to both genders, and this decrease is more obvious in women and in the population aged over 75 (data not shown). This decline might contribute to the decreasing trend of peptic ulcer death and re-bleeding in women.…”