Retrospective Study
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World J Gastroenterol. Aug 14, 2014; 20(30): 10504-10511
Published online Aug 14, 2014. doi: 10.3748/wjg.v20.i30.10504
One fifth of hospitalizations for peptic ulcer-related bleeding are potentially preventable
Ray Boyapati, Sim Ye Ong, Bei Ye, Anuk Kruavit, Nora Lee, Rhys Vaughan, Sanjay Nandurkar, Peter Gibson, Mayur Garg
Ray Boyapati, Sim Ye Ong, Bei Ye, Rhys Vaughan, Mayur Garg, Gastroenterology and Liver Transplant Unit, Austin Hospital, Melbourne, Victoria 3128, Australia
Anuk Kruavit, Nora Lee, Sanjay Nandurkar, Peter Gibson, Mayur Garg, Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Melbourne, Victoria 3128, Australia
Peter Gibson, Department of Gastroenterology, The Alfred Hospital and Monash University, Melbourne, Victoria 3128, Australia
Author contributions: Boyapati R contributed to the collection of data, literature review, analysis of data, and writing of manuscript; Ong SY, Ye B, Kruavit A and Lee N contributed to the collection of data, review of manuscript; Vaughan R, Nandurkar S and Gibson P contributed to the intellectual planning, critical appraisal of manuscript; Garg M contributed to the intellectual planning, literature review, collection of data, analysis of data, writing and critical appraisal of the manuscript.
Correspondence to: Mayur Garg, Gastroenterologist, Department of Gastroenterology and Hepatology, Eastern Health and Monash University, Level 2, 5 Arnold St, Box Hill, Victoria 3128, Australia. mayur.garg@monash.edu
Telephone: +61-4-10624366 Fax: +61-3-98999137
Received: January 12, 2014
Revised: February 28, 2014
Accepted: April 21, 2014
Published online: August 14, 2014
Abstract

AIM: To calculate the proportion of potentially preventable hospitalizations due to peptic ulcer disease (PUD), erosive gastritis (EG) or duodenitis (ED).

METHODS: Retrospective cohort study using ICD-10 codes to identify all patients with upper gastrointestinal hemorrhage secondary to endoscopically proven PUD, EG or ED during the period from March 2007 to October 2010 in three major metropolitan hospitals in Melbourne, Australia. Patients were divided into “high risk” (those who would benefit from gastroprotection) and “not high risk” groups as defined by established guidelines. Mean Rockall score, transfusion requirement, length of stay, rebleeding rates, need for surgery and in-hospital mortality was compared between “high risk” and “not high risk” groups. Within the “high risk” group, those on gastroprotection and those with no gastroprotection were also compared.

RESULTS: Five hundred and seven patients were included for analysis of which 174 were classified as high risk. Median values of complete Rockall Score (5 vs 4, P = 0.002) and length of stay (5 d vs 4 d, P = 0.04) were higher in the high risk group but in-hospital mortality was lower (0.6% vs 3.9%, P = 0.03). 130 out of the 174 patients in the high risk group were not taking recommended gastroprotective therapy prior to hospitalization. Past history of PUD (OR = 3.7, P = 0.006) and clopidogrel use (OR = 3.2, P = 0.007) significantly predicted prescription of gastroprotective therapy. Using proton pump inhibitor protection rates of 50%-85% from published studies, an estimation of 13% to 22% of the total number of the hospitalizations due to PUD or EG/ED related bleeding may have been preventable.

CONCLUSION: Up to one fifth of all hospitalizations for bleeding secondary to PUD or EG/ED are potentially preventable.

Keywords: Peptic ulcer, Gastrointestinal hemorrhage, Prevention, Non-steroidal anti-inflammatory drug, Proton pump inhibitor, Gastroprotection

Core tip: Gastroprotective therapies reduce the risk of bleeding from peptic ulcer disease. For certain high risk groups, the risk reduction is significant: in the order of 50%-85%. Despite this, gastroprotection is still underutilised in this setting. It is unclear what proportion of hospitalizations that occur due to peptic ulcer disease bleeding is preventable. This original research finds that adherence to gastroprotective therapies in high risk populations is poor, and that up to one fifth of all hospitalizations due to peptic ulcer disease related bleeding are potentially preventable.