Changes of gastric ulcer bleeding in the metropolitan area of Japan
Changes of gastric ulcer bleeding in the metropolitan area of Japan
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DOI：
10.3748/wjg.v25.i42.6342
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发表时间：
2019-11-14
影响因子：
4.3
通讯作者：
Suzuki, Hidekazu
中科院分区：
文献类型：
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作者：
Kubosawa, Yoko;Mori, Hideki;Suzuki, Hidekazu
胃溃疡出血的两个主要原因是幽门螺杆菌（H.幽门螺杆菌）感染和致溃疡药物，尽管每种药物引起的病例数可能随年龄而变化。在日本，H.幽门螺杆菌感染在过去十年中已经下降，并且随着人口年龄的增长，非甾体抗炎药（NSAID）和抗血栓形成药物的处方数量正在增加。随着止血钳和钾竞争性酸阻断剂（P-CAB）的出现，胃溃疡出血的治疗方法也有所进步。因此，原因和治疗胃溃疡出血已经改变了在过去的decade.AIMTo检查的趋势，胃溃疡出血超过10年的大都市地区的Japan. METHODS这是一个单中心的回顾性研究。从2006年至2016年期间在我院住院的胃溃疡出血患者中共招募了564例患者。年龄、用药史、H. pylori感染、治疗方法、再出血率及住院时间进行分析。使用Fisher精确检验、Pearson卡方检验或Student t检验（如适用）评价胃溃疡出血相关因素。Jonckheere-Terpstra检验用于评价趋势。采用符合方案分析方法检测H. pylori感染者的平均年龄随时间的推移而显著增加（P < 0.01）。H.在研究期间，幽门螺杆菌感染倾向于减少（P = 0.10），而服用抗血栓药物或NSAID的患者比例倾向于增加（P = 0.07）。随着时间的推移，NSAID和抗血栓药物的使用随着年龄的增长而增加。而H.幽门螺杆菌感染在研究期间随着年龄的增长而下降。H.幽门相关性溃疡在年轻患者（< 70岁）中占大多数，但其发生率随年龄增长而下降（P < 0.01）。随着时间的推移，治疗方法的趋势发生了重大变化。内镜下止血方法由夹闭、注射为主转变为钳凝为主（P < 0.01），常用药物由质子泵抑制剂转变为P-CAB（P < 0.01）。结论：随着年龄的增长，致溃疡药物引起的胃溃疡有增加的趋势，且随着年龄的增长，H.幽门引起的溃疡在年轻患者中更常见。
BACKGROUNDThe 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.AIMTo examine the trends of gastric ulcer bleeding over 10 years in the metropolitan area of Japan.METHODSThis 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.RESULTSThere 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.CONCLUSIONThese trends, gastric ulcers caused by ulcerogenic drugs were increasing with age and H. pylori-induced ulcers were more common in younger patients, were observed.