Butt N, Usmani MT, Mehak N, Mughal S, Qazi-Arisar FA, Mohiuddin G, Khan G. Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study. World J Gastrointest Pharmacol Ther 2024; 15(3): 92305 [PMID: 38846968 DOI: 10.4292/wjgpt.v15.i3.92305]
Corresponding Author of This Article
Fakhar Ali Qazi-Arisar, FACP, FCPS, FRCP, MBBS, MRCP, Assistant Professor, National Institute of Liver & GI Diseases, Dow University of Health Sciences, Suparco Road, Gulzar-e-Hijri, Scheme 33, Karachi 75330, Sindh, Pakistan. fakhar.arisar@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. May 28, 2024; 15(3): 92305 Published online May 28, 2024. doi: 10.4292/wjgpt.v15.i3.92305
Risk factors and outcomes of peptic ulcer bleed in a Pakistani population: A single-center observational study
Nazish Butt, Muhammad Tayyab Usmani, Nimrah Mehak, Saba Mughal, Fakhar Ali Qazi-Arisar, Ghulam Mohiuddin, Gulzar Khan
Nazish Butt, Nimrah Mehak, Ghulam Mohiuddin, Gulzar Khan, Department of Gastroenterology, Jinnah Postgraduate Medical Centre, Karachi 75505, Sindh, Pakistan
Muhammad Tayyab Usmani, Fakhar Ali Qazi-Arisar, National Institute of Liver & GI Diseases, Dow University of Health Sciences, Karachi 75330, Sindh, Pakistan
Saba Mughal, School of Public Health, Dow University of Health Sciences, Karachi 75330, Sindh, Pakistan
Author contributions: But N designed the research study; Mehak N, Mohiuddin G and Khan G performed the data collection; Mughal S analyzed the data; Usmani MT wrote the manuscript; Qazi-Arisar FA revised the manuscript; But N and Qazi-Arisar FA supervised the research; all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board (IRB) of Jinnah Postgraduate Medical Centre. The study was conducted in accordance with the ethical principles outlined in the Belmont Report and the Declaration of Helsinki.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: Dr. Qazi Arisar has nothing to disclose.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fakhar Ali Qazi-Arisar, FACP, FCPS, FRCP, MBBS, MRCP, Assistant Professor, National Institute of Liver & GI Diseases, Dow University of Health Sciences, Suparco Road, Gulzar-e-Hijri, Scheme 33, Karachi 75330, Sindh, Pakistan. fakhar.arisar@gmail.com
Received: January 22, 2024 Revised: April 24, 2024 Accepted: May 20, 2024 Published online: May 28, 2024 Processing time: 125 Days and 12.1 Hours
Abstract
BACKGROUND
Peptic ulcer disease (PUD) remains a significant healthcare burden, contributing to morbidity and mortality worldwide. Despite advancements in therapies, its prevalence persists, particularly in regions with widespread nonsteroidal anti-inflammatory drugs (NSAIDs) use and Helicobacter pylori infection.
AIM
To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal (GI) bleeding in Pakistani population.
METHODS
This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022. Data on demographics, symptoms, length of stay, mortality, re-bleed, and Forrest classification was collected.
RESULTS
The mean age of patients was 53 years, and the majority was men (68.3%). Hematemesis (82.4%) and epigastric pain (75.4%) were the most common presenting symptoms. Most patients (73.2%) were discharged within five days. The mortality rates at one week and one month were 10.6% and 14.8%, respectively. Re-bleed within 24 h and seven days occurred in 14.1% and 18.3% of patients, respectively. Most ulcers were Forrest class (FC) III (72.5%). Antiplatelet use was associated with higher mortality at 7 and 30 d, while alternative medications were linked to higher 24-hour re-bleed rates. NSAID use was associated with more FC III ulcers. Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.
CONCLUSION
Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding, while alternative medicines are associated with early rebleeding.
Core Tip: This Pakistani study flags antiplatelets and alternative meds as risk factors for peptic ulcer bleeding mortality and re-bleed. Considering patient comorbidities and tailoring treatment based on these factors, like avoiding antiplatelets if possible, could improve outcomes in this population. However, larger studies are needed to solidify these findings and personalize treatment further.
