Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2019; 25(42): 6342-6353
Published online Nov 14, 2019. doi: 10.3748/wjg.v25.i42.6342
Changes of gastric ulcer bleeding in the metropolitan area of Japan
Yoko Kubosawa, Hideki Mori, Satoshi Kinoshita, Yoshihiro Nakazato, Ai Fujimoto, Masahiro Kikuchi, Toshihiro Nishizawa, Masayuki Suzuki, Hidekazu Suzuki
Yoko Kubosawa, Hideki Mori, Satoshi Kinoshita, Yoshihiro Nakazato, Ai Fujimoto, Masahiro Kikuchi, Toshihiro Nishizawa, Masayuki Suzuki, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Meguro, Tokyo 152-8902, Japan
Yoko Kubosawa, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku, Tokyo 160-0016, Japan
Hideki Mori, Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Diseases (TARGID), University of Leuven, Leuven 3000, Belgium
Toshihiro Nishizawa, Department of Gastroenterology, Digestive Disease Center, International University of Health and Welfare, Mita Hospital, Minato, Tokyo 108-8329, Japan
Hidekazu Suzuki, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
Author contributions: All authors helped to perform the research; Kubosawa Y contributed to manuscript writing, performing procedures and data analysis; Mori H contributed manuscript writing, drafting conception and design, and date analysis; Kinoshita S, Nakazato Y, Fujimoto A, Kikuchi M, Nishizawa T, Suzuki M contributed to writing the manuscript; Hidekazu Suzuki contributed to writing the manuscript, drafting conception and design.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the National Hospital Organization Tokyo Medical Center.
Informed consent statement: Written informed consent was not required, and informed consent included an opt-out clause approved by the Medical Ethics Committee.
Conflict-of-interest statement: During the last 3 years, Suzuki H. received scholarship funds for research from Daiichi-Sankyo Co., EA Pharma Co., Otsuka Pharmaceutical Co. Ltd., and Tsumura Co., and received service honoraria from Astellas Pharma Inc., AstraZeneca K.K., Daiichi-Sankyo Co., EA Pharma Co., Otsuka Pharmaceutical Co. Ltd., Mylan EPD Co., Takeda Pharmaceutical Co. Ltd., Tsumura Co., and Zeria Pharmaceutical Co. Ltd. The other authors have no conflicts of interest to declare.
Data sharing statement: No additional data is available.
Open-Access: This 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 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/
Corresponding author: Hideki Mori, MD, PhD, Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro, Tokyo 152-8902, Japan. koyamaru2002@yahoo.co.jp
Telephone: +81-3-34000111 Fax: +81-3-34129811
Received: May 26, 2019
Peer-review started: May 27, 2019
First decision: July 21, 2019
Revised: September 11, 2019
Accepted: November 1, 2019
Article in press: November 1, 2019
Published online: November 14, 2019
Abstract
BACKGROUND

The two main causes of gastric ulcer bleeding are Helicobacter pylori (H. pylori) infection and ulcerogenic medicines, although the number of cases caused by each may vary with age. In Japan, the rate of H. pylori infection has fallen over the last decade and the number of prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) and antithrombotic drugs is increasing as the population ages. Methods of treatment for gastric ulcer bleeding have advanced with the advent of hemostatic forceps and potassium-competitive acid blocker (P-CAB). Thus, causes and treatments for gastric ulcer bleeding have changed over the last decade.

AIM

To examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.

METHODS

This is a single-center retrospective study. A total of 564 patients were enrolled from inpatients admitted to our hospital with gastric ulcer bleeding between 2006 and 2016. Age, medication history, H. pylori infection, method of treatment, rate of rebleeding, and the length of hospitalization were analyzed. Factors associated with gastric ulcer bleeding were evaluated using Fisher’s exact test, Pearson’s Chi-squared test or Student’s t-test as appropriate. The Jonckheere-Terpstra test was used to evaluate trends. A per-protocol analysis was used to examine the rate of H. pylori infection.

RESULTS

There was a significant increase in the mean age over time (P < 0.01). The rate of H. pylori infection tended to decrease over the study period (P = 0.10), whereas the proportion of patients taking antithrombotic agents or NSAIDs tended to increase (P = 0.07). Over time, the use of NSAIDs and antithrombotic drugs increased with age. By contrast, the rate of H. pylori infection during the study period fell with age. H. pylori-induced ulcers accounted for the majority of cases in younger patients (< 70 years old); however, the rate decreased with age (P < 0.01). The method of treatment trend has changed significantly over time. The main method of endoscopic hemostasis has changed from clipping and injection to forceps coagulation (P < 0.01), and frequently prescribed medicines have changed from proton pump inhibitor to P-CAB (P < 0.01). The rate of rebleeding during the latter half of the study was significantly lower than that in the first half.

CONCLUSION

These trends, gastric ulcers caused by ulcerogenic drugs were increasing with age and H. pylori-induced ulcers were more common in younger patients, were observed.

Keywords: Helicobacter pylori infection, Gastric ulcer bleeding, Non-steroidal anti-inflammatory drugs, Antithrombotic agents

Core tip: The two main causes of gastric ulcer bleeding are Helicobacter pylori (H. pylori) infection and ulcerogenic medicines, although the number of cases caused by each may vary with age. The aim of this study was to examine changes of gastric ulcer bleeding over 10 years. The mean age increased significantly. The rate of H. pylori infection tended to decrease, whereas the proportion of patients taking antithrombotic agents or non-steroidal anti-inflammatory drugs tended to increase. H. pylori-induced ulcers accounted for the majority in younger patients and the proportion of gastric ulcers caused by ulcerogenic drugs was increasing with age.