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The Changing Face of Hospitalization Due to Gastrointestinal Bleeding And The changing face of hospitalization due to gastrointestinal bleeding and perforation Angel Lanas, Luis Alberto Garcia Rodriguez, Monica Polo-Tomas, Marta Ponce, Enrique Quintero, Maria Angeles Perez-Aisa, Javier P Gisbert, Luis Bujanda, Manuel Castro, Maria Muñoz, et al. To cite this version: Angel Lanas, Luis Alberto Garcia Rodriguez, Monica Polo-Tomas, Marta Ponce, Enrique Quintero, et al.. The changing face of hospitalization due to gastrointestinal bleeding and perforation. Alimentary Pharmacology and Therapeutics, Wiley, 2011, 33 (5), pp.585. 10.1111/j.1365-2036.2010.04563.x. hal-00605960 HAL Id: hal-00605960 https://hal.archives-ouvertes.fr/hal-00605960 Submitted on 5 Jul 2011 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Alimentary Pharmacology & Therapeutic The changing face of hospitalization due to gastrointestinal bleeding and perforation ForJournal: Alimentary Peer Pharmacology Review & Therapeutics Manuscript ID: APT-0637-2010.R2 Wiley - Manuscript type: Original Scientific Paper Date Submitted by the 11-Dec-2010 Author: Complete List of Authors: Lanas, Angel; University Hospital Lozano Blesa, Gastroenterology; University of Zaragoza. School of Medicine, Medicine; CIBERehd Garcia Rodriguez, Luis Alberto; Centro Español de Investigacion Farmacoepidemiologica (CEIFE) Polo-Tomas, Monica; CIBERehd, Division of Gastroenterology Ponce, Marta; Hospital la Fe, Gastroenterology Unit Quintero, Enrique; Hospital Universitario de la Laguna, Gastroenterology Perez-Aisa, Maria; Hospital Costa del Sol, Gastroeneterology Gisbert, Javier; Hospital de la Princesa-CIBERehd, Division of Gastroenterology Bujanda, Luis; Hospital Donostia. CIBERehd, Gastroenterology Castro, Manuel; Hospital de Valme. CIBERehd, Gastroenterology Department Muñoz, Maria; University Hospital Lozano Blesa, Gastroenterology Del Pino, Maria Dolores; University Hospital Lozano Blesa, Gastroenterology Garcia, Santiago; Hospital Universitario Miguel Servet, Gastroenterology Calvet, Xavier; Parc Tauli, Gastroenterology Peptic ulcer disease < Disease-based, Diverticular disease < Keywords: Disease-based, Stomach and duodenum < Organ-based, Epidemiology < Topics, NSAIDs < Topics Page 1 of 30 Alimentary Pharmacology & Therapeutic 1 1 2 3 4 5 6 The changing face of hospitalization due to gastrointestinal bleeding and 7 8 perforation 9 10 11 Authors: 12 1,2,3 4 2 13 Angel Lanas, Luis A. García-Rodríguez, Mónica Polo-Tomás , Marta 14 5,2 6 7 8,2 15 Ponce , Enrique Quintero, Maria Angeles Perez-Aisa , Javier P. Gisbert 16 Luis Bujanda 9,2 , Manuel Castro 10,2 , Maria Muñoz 1, Dolores Del-Pino 12 , Santiago 17 13 14 ,2 18 Garcia , Xavier Calvet 19 20 Affiliations For Peer Review 21 1 22 Servicio de Aparato Digestivo, Hospital Clínico. Universidad de Zaragoza. Spain 23 2 Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas 24 25 (CIBERehd). Spain 26 3 Instituto Aragonés de Ciencias de la Salud (IACS) 27 28 4 Centro Español de Investigación Farmacoepidemiológica. Madrid. Spain 29 5 30 Servicio de Aparato Digestivo. Hospital La Fe. Valencia 31 6Servicio de Aparato Digestivo. Hospital Universitario de Canarias. La Laguna. Tenerife. 32 33 Spain. 34 7 35 . Servicio de Aparato Digestivo. Hospital Costa del Sol. Marbella. Spain. 36 8. Servicio de Aparato Digestivo. Hospital de la Princesa. Madrid. Spain. 37 9 38 Servicio de Aparato Digestivo. Hospital Donostia Universidad del País Vasco. San 39 Sebastián. Spain. 40 41 10 Servicio de Aparato Digestivo. Hospital de Valme.- Sevilla. Spain. 42 11 43 . Servicio de Aparato Digestivo. Hospital de Asturias. Oviedo. Spain. 44 12 . Servicio de Codificación. Hospital Clínico Universitario. Zaragoza. Spain 45 46 13 Servicio de Aparato Digestivo. Hospital Universitario Miguel Servet. Zaragoza. Spain 47 14 48 Servicio de Aparato Digestivo. Hospital de Sabadell. Barcelona. Spain 49 50 51 Short title: Trends in GI hospitalizations 52 53 To whom correspondence should be addressed: 54 55 Angel Lanas. Servicio de Aparato Digestivo. Hospital Clínico Universitario. C/ San Juan 56 57 Bosco 15. 50009 Zaragoza. Spain. Phone: 34 976765786; Fax: 34 976765787). 58 Email: [email protected] 59 60 Alimentary Pharmacology & Therapeutic Page 2 of 30 2 1 2 3 4 5 6 Abstract: 7 8 9 Background: Temporal changes in the incidence of cause-specific 10 gastrointestinal (GI) complications may be one of the factors underlying 11 12 changing medical practice patterns . Aim: To report temporal changes in the 13 14 incidence of five major causes of specific gastrointestinal (GI) complication 15 16 events. Methodology: Population-based study of patients hospitalized due to 17 GI bleeding and perforation from 1996–2005 in Spain. We report crude rates, 18 19 and estimate regression coefficients of temporal trends, severity, and recorded 20 For Peer Review 21 drug use for 5 frequent GI events. GI hospitalization charts were validated by 22 23 independent review of large random samples. Results: The incidence per 24 25 100,000 person-years of hospitalizations due to upper GI ulcer bleeding and 26 perforation decreased over time (from 54.6 and 3.9 in 1996 [R2=0.944] to 25.8 27 28 and 2.9 in 2005 [R 2=0.410], respectively). On the contrary, the incidence per 29 30 100,000 person-years of colonic diverticular and angiodysplasia bleeding 31 2 32 increased over time (3.3 and 0.9 in 1996 [R =0.443] and 8.0 and 2.6 in 2005 33 [R 2=0.715], respectively). A small increasing trend was observed for the 34 35 incidence per 100,000 person-years of intestinal perforations (from 1.5 to 2.3 36 37 events). Based on data extracted from the validation process, recent recorded 38 39 drug intake showed an increased frequency of anticoagulants with colonic 40 41 diverticular and angiodysplasia bleeding, whereas NSAID and low-dose aspirin 42 use were more prevalent in peptic ulcer bleeding and colonic diverticular 43 44 bleeding respectively. Conclusions: From 1996–2005, hospitalizations due to 45 46 peptic ulcer bleeding and perforation have decreased significantly, whereas the 47 48 number of cases of colonic diverticular and angiodysplasia bleeding have 49 increased. 50 51 52 53 54 55 56 57 Key words: peptic ulcer, bleeding, perforation, angiodysplasia, diverticulum 58 59 60 Page 3 of 30 Alimentary Pharmacology & Therapeutic 3 1 2 3 4 5 Background 6 7 Gastrointestinal (GI) complications are major causes of hospitalization. 8 9 Major therapeutic advances in the treatment and prevention of peptic ulcer 10 diseases have been implemented in the past decade, which should contribute 11 12 to a significant decrease in the incidence and mortality due to peptic ulcer 13 14 diseases. Opposing trends in peptic ulcer complications such as bleeding or 15 16 perforation have been reported in different countries, and no decrease or 17 18 increase in hospitalizations due to peptic ulcer bleeding complications have 19 been observed (1-6). More recently, two studies from different geographical 20 For Peer Review 21 areas suggested that there has been a marked decrease in the incidence of 22 23 upper GI complications and a slight increase in the incidence of lower GI 24 25 complications (7,8); however, the specific lesions leading to these changes 26 have not been analyzed. Furthermore, the time trends for bleeding and 27 28 perforation may not be parallel, since the underlying pathogenic mechanisms 29 30 and risk factors could diverge (9,10). Additionally, the exact source of lower GI 31 32 complications are often more difficult to identify than upper GI complications 33 34 because of the anatomic complexity of the lower gut and available diagnostic 35 tests. Among the causes of lower GI bleeding, colonic diverticuli and 36 37 angiodysplasia are two lesions which could explain, at least in part, the recent 38 39 trends, since age was found to be one of the main risk factors for 40 41 hospitalizations (7). However, the time trends and clinical characteristics of 42 hospitalizations owing to these two lesions have not been reported. 43 44 Prevention strategies and optimization of hospital resources require a 45 46 clear understanding of the type of pathology causing hospitalization. In a 47 48 previous report, we presented the overall time trends of hospitalizations due to 49 GI complications, (7) which were obtained from a data-base including 50 51 information provided by 10 Spanish general hospitals representative of the 52 53 entire country (11). Now, as part of the pre-specified analysis plan, we aim to 54 55 characterize and analyze in detail the time trends for hospitalizations due to five 56 57 specific major causes of GI complications; namely, peptic ulcer bleeding, peptic 58 ulcer perforation, intestinal perforation, colonic diverticular bleeding, and 59 60 bleeding caused by angiodysplasia. We believe that these data are needed since, as discussed above, the available literature for some of these causes and Alimentary Pharmacology & Therapeutic Page 4 of 30 4 1 2 3 the comparative trends among them are sparse or absent. Additionally, we also 4 5 describe the severity characteristics and recorded drug use for each of these 6 7 entities. 8 9 10 Methods: 11 12 13 14 Setting and data collection 15 16 The study (7) was approved by the Institutional Review Board of Aragón 17 18 and was carried out in 10 Spanish general hospitals distributed across the 19 entire country, serving a population of 3,281,973 people in 1996 and 3,681,822 20 For Peer Review 21 in 2005. Based on previous reports (11), the population covered by these 22 23 hospitals was representative of the whole country, where the majority (80%) of 24 25 the population uses the Spanish NHS, which provides open access free-to-all 26 healthcare services including hospitals, drugs, and diagnostic and therapeutic 27 28 procedures.
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