Recent trends in the occurrence of bleeding gastric and duodenal ulcers under the Japanese evidence‐based clinical practice guideline for peptic ulcer disease

Abstract

Background: Gastrointestinal hemorrhage occurs frequently. We reviewed the tendency of occurrence of bleeding gastric and duodenal ulcers and their association with antithrombotic therapy before and after the widespread use of Evidence-Based Clinical Practice Guidelines for Peptic Ulcer 2009 (1st edition), which was published to improve treatment outcomes and prevent peptic ulcers. Methods: The study enrolled 1105 patients with bleeding gastric and duodenal ulcers treated at our hospital between January 2000 and March 2016. They were divided into the preguideline group (807 patients treated between January 2000 and December 2010) and the postguideline group (298 patients treated between January 2011 and March 2016). The use of medications, severity, the incidence of Helicobacter pylori infection, the presence of any underlying disease, and other factors were compared between the pre-and postguideline groups. Results: The number of patients receiving antithrombotic therapy was slightly higher in the postguideline group without a significant difference (P = 0.50). The incidence of H. pylori infection was significantly lower in the postguideline group (P < 0.001). The rate of premedication with a proton pump inhibitor (PPI) and the rate of severe ulcers were significantly higher in the postguideline group (P = 0.001 and P < 0.001, respectively). The rebleeding rate showed no significant difference, whereas the recurrence rate was significantly higher in the postguideline group (P = 0.041). Conclusions: The major cause of hemorrhagic gastroduodenal ulcers seems to be shifting from H. pylori infection to the administration of drugs with gastrointestinal risk. Antithrombotic therapy tends to be associated with severe ulcers but without statistical significance.

Diagnosis and Treatment of Peptic Ulcer in Adults (Clinical Guidelines of the Russian Gastroenterological Association, Russian Society of Colorectal Surgeons and the Russian Endoscopic Society)

“…Абсолютное число пациентов с желудочно-кишечными кровотечениями, в том числе язвенной этиологии, за анализируемый период времени также уменьшилось, однако послеоперационная летальность снизилась незначительно. Аналогичная ситуация отмечена группой японских ученых, указавших на снижение значимости наличия Н. pylori для пациентов с язвенными кровотечениями [10].…”

“…Комментарии ной воспалительной реакции, после чего могут быть применены хирургический и/или эндоскопический методы лечения [10,37,38,42,43]. Важно отметить, что при язвенном кровотечении риск смерти коморбидного пациента прямо коррелирует с количеством сопутствующих заболеваний [44].…”

“…• Пациентам с язвенным кровотечением экстренное хирургическое вмешательство с целью верификации источника кровотечения и его остановки рекомендуется проводить при неэффективности эндоскопического гемостаза в максимально ранние сроки [10,37,38,49].…”

“…Комментарии [10]. Наилучший результат при лечении рефрактерных осложненных язв отмечен при сочетании резекции желудка с наложением гастроеюноанастомоза и ваготомией [50], однако в зарубежной литературе ваготомия рассматривается как сложная, ограниченно применимая опция, для полноценного признания которой должны быть проведены исследования высокого уровня доказательности [51].…”

Analysis of staged treatment and some socio-hygienic and biological factors for the onset and course of gastric ulcer and duodenal ulcer

“…Clinical examination as a method of prevention in the social aspect of diseases has turned into a scientific and organizational system that includes such factors as improving the speed of work and life, preventive and curative health-improving measures, and dynamical monitoring of the state of health of the violence. Therefore, the identification of such moments in the onset of peptic ulcer disease called "risk factors" is of great scientific and practical importance [1][2][3][4][5]. At the same time according to the recognition of researchers, few works are devoted to the study of socio-hygienic factors of the course of peptic ulcer disease of the stomach and duodenum (including the identification of "risk factors") [6][7][8][9] In the study of 14 polyclinics and 8 hospitals, we received data for adults in Samarkand city, as well as regional institutions -the archive of the Marriage registry office and the Statistical Office, Medical Labor Expert Commission of the city, and the Regional Trade Union.…”