Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
Usher Institute, University of Edinburgh, Edinburgh, UK.
United European Gastroenterol J. 2021 Jun;9(5):543-551. doi: 10.1002/ueg2.12067. Epub 2021 May 6.
With the increasing use of medications that alter the risk of gastrointestinal bleeding (GIB), comprising aspirin, proton pump inhibitors (PPIs), and Helicobacter pylori eradication therapies, the trends of GIB are evolving.
The aim of this study is to determine and predict the trends of GIB and to evaluate the effects of population prescriptions of these medications on GIB incidences.
We retrieved patients hospitalized for GIB in all public hospitals in Hong Kong between 2009 and 2019. Monthly age- and sex-standardized GIB data were fitted and predicted, based on population prescriptions of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, other antiplatelet drugs, PPIs, and H. pylori therapies, using autoregressive integrated moving average model for time series analysis.
The incidence of upper GIB (UGIB) showed a clear declining trend while lower GIB (LGIB) decreased slightly. Older population (>80 years) had the greatest decline in UGIB but was associated with an increase in LGIB. Prescriptions of PPIs and aspirin increased significantly with time. PPIs prescriptions were negatively associated with UGIB incidence (coefficient log(PPIs) -4.58; 95% confidence interval [CI]: -5.69, -3.47). H. pylori eradication in the previous month showed a nonsignificant trend on UGIB (coefficient -0.14; 95% CI: -0.30, 0.02). In contrast, aspirin increased the incidences of UGIB (coefficient 0.06; 95% CI: 0.04, 0.07) and LGIB (coefficient 0.04; 95% CI: 0.03, 0.05). NSAIDs, anticoagulants, and other antiplatelet drugs were not significantly associated with the trend of either UGIB or LGIB. UGIB is predicted to decline continuously but LGIB is projected to rise, particularly with increasing use of aspirin.
UGIB incidences were decreasing and had been surpassed by LGIB. Based on population prescriptions of aspirin and PPIs, divergent trends of upper and lower GIB are expected, especially in elderly.
随着改变胃肠道出血（GIB）风险的药物（包括阿司匹林、质子泵抑制剂（PPIs）和幽门螺杆菌根除疗法）的使用增加，GIB 的趋势正在发生变化。
本研究旨在确定和预测 GIB 的趋势，并评估这些药物的人群处方对 GIB 发生率的影响。
我们检索了 2009 年至 2019 年期间在香港所有公立医院因 GIB 住院的患者。基于阿司匹林、非甾体抗炎药（NSAIDs）、抗凝剂、其他抗血小板药物、PPIs 和 H. pylori 治疗的人群处方，使用自回归综合移动平均模型进行时间序列分析，对年龄和性别标准化的每月 GIB 数据进行拟合和预测。
上胃肠道出血（UGIB）的发生率呈明显下降趋势，而下胃肠道出血（LGIB）略有下降。年龄较大的人群（>80 岁）的 UGIB 下降幅度最大，但与 LGIB 的增加有关。PPIs 和阿司匹林的处方量随时间显著增加。PPIs 处方与 UGIB 发生率呈负相关（系数 log(PPIs) -4.58；95%置信区间 [CI]：-5.69，-3.47）。前一个月 H. pylori 根除治疗对 UGIB 的趋势无显著影响（系数-0.14；95%CI：-0.30，0.02）。相比之下，阿司匹林增加了 UGIB（系数 0.06；95%CI：0.04，0.07）和 LGIB（系数 0.04；95%CI：0.03，0.05）的发生率。NSAIDs、抗凝剂和其他抗血小板药物与 UGIB 或 LGIB 的趋势均无显著相关性。预计 UGIB 的发生率将继续下降，但 LGIB 的发生率预计将上升，尤其是随着阿司匹林的使用增加。
UGIB 的发生率正在下降，且已被 LGIB 超越。基于阿司匹林和 PPIs 的人群处方，预计上消化道和下消化道出血的趋势将出现分歧，尤其是在老年人中。
