Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia.
Intern Med J. 2011 Aug;41(8):605-9. doi: 10.1111/j.1445-5994.2010.02357.x.
Peptic ulcer disease risk factors have changed, as has the impact of treatment on morbidity and mortality. Recent data on clinical presentation and outcome are sparse in Australia.
To determine the characteristics and outcome of patients presenting with a bleeding peptic ulcer to a tertiary referral centre.
We evaluated patients diagnosed with peptic ulcer bleeding between 2004 and 2008 at a tertiary referral hospital. Variables assessed included demographic data, comorbidities, medication use and Rockall score. Outcomes of interest were the time to endoscopy, peptic ulcer treatment, transfusion requirements, urgent surgery and survival.
Peptic ulcers were confirmed in 265 patients (55% male), of which 145 were gastric and 119 duodenal. The mean age was 71 years. On admission 38% of patients had haemodynamic instability and 92% had one or more comorbidity. Consumption of ulcerogenic medications at the time of admission was frequent (non-steroidal anti-inflammatory drugs (NSAIDs) 22%, aspirin 41%, clopidogrel or warfarin 10%) and proton pump inhibitors infrequent (15%). A gastroenterologist managed all patients according to their usual practice. Only a minority of patients received over three units of packed red cells. Few patients were referred for surgery (3%) or died (3%), but both events were significantly higher for the duodenal ulcer group.
The characteristics and outcomes in patients with peptic ulcer bleeding have changed. Peptic ulcer disease remains a public health problem with modifiable risk factors, such as Helicobacter pylori infection and NSAIDs, which should be targeted to reduce the burden of illness.
消化性溃疡的发病因素已发生变化，治疗对发病率和死亡率的影响亦随之改变。目前有关澳大利亚消化性溃疡出血患者临床表现和结局的最新数据较为缺乏。
旨在明确在三级转诊中心就诊的出血性消化性溃疡患者的特征和结局。
我们评估了 2004 年至 2008 年期间在一家三级转诊医院被诊断为消化性溃疡出血的患者。评估的变量包括人口统计学数据、合并症、用药情况和 Rockall 评分。感兴趣的结局包括内镜检查时间、消化性溃疡治疗、输血需求、紧急手术和生存率。
265 例（55%为男性）患者被确诊为消化性溃疡，其中 145 例为胃溃疡，119 例为十二指肠溃疡。平均年龄为 71 岁。入院时 38%的患者存在血流动力学不稳定，92%的患者存在 1 种或多种合并症。入院时使用致溃疡药物的情况较为常见（非甾体抗炎药 22%，阿司匹林 41%，氯吡格雷或华法林 10%），质子泵抑制剂的使用则不常见（15%）。所有患者均根据其常规治疗方案由胃肠病专家进行管理。仅有少数患者接受超过 3 个单位的浓缩红细胞输注。仅有少数患者（3%）被转诊接受手术或死亡（3%），但十二指肠溃疡组这两种情况的发生率明显更高。
消化性溃疡出血患者的特征和结局已经发生改变。消化性溃疡疾病仍然是一个存在可改变的危险因素（如幽门螺杆菌感染和非甾体抗炎药）的公共卫生问题，应针对这些因素进行干预，以降低疾病负担。
