Bleeding upper gastrointestinal ulcers: Epidemiology and management. Multicentre prospective study.

The aim of this study was to estimate the incidence, and to describe the ch aracteristics and medical care in patients with bleeding upper gastrointest inal ulcers in the general population. Patients and methods: A Study was pe rformed over six months in 1996 in 4 French geographical areas: Finistere, Gironde, Sine-Maritime, and the Somme (3 million people minimum 18 years). All public or private hospitals, and specialist gastroenterologists in priv ate practice participated in the study, based on a standardised questionnai re. Results. Over 6 months 793 patients with bleeding ulcers were identifie d, corresponding to 27 per 100,00 inh./year or 24,000 cases in France. Most patients were men (60%) and 40.1% were 75 years and older. The ulcer was o esophageal (6%), gastric (47%), or duodenal (69%). In 406 patients (51.2%) a chronic disease was present (cancer, cirrhosis, circulatory, respiratory or cardiac disease). In 237 cases (29.9%) the ulcer occurred in patients, 4 53 patients (57.1%) were admitted and 103 patients (13%) were managed as ou tpatients. Gastrotoxic drugs were taken by 349 patients (44%): non steroida l anti-inflammatory drugs (18.7%), aspirin (21.2%, including 2/3 with doses under 330 mg/day), corticosteroids (7.8%) and 24.3% had anticoagulant ther apy. Patients were managed in university hospitals (39.3%), other public or non profit hospitals (44.2%) or private hospital (16.5%) with geographical differences between the 4 areas. Therapeutic endoscopy was performzed in 1 6.9% and a surgical procedure was performed in 5.9%. The mortality rate (ou tpatients excluded) was 13.5% (n = 93), but only 2% (n = 16) of death were associated with a bleeding ulcer: mortality was higher in inpatients (24.1% ) than in out patients (8.1%); A chronic disease was also associated with h igher mortality (17.9% versus 8.1%). Conclusion : Bleeding ulcers are frequ ent and severe, especially in inpatients or associated with chronic conditi ons. A gastrotoxic drug used is found in about fifty percent of the cases.