Hudson N, Faulkner G, Smith S J, Logan R F, Hawkey C J
Department of Medicine, University Hospital, Nottingham.
Gut. 1995 Aug;37(2):182-6. doi: 10.1136/gut.37.2.182.
Bleeding peptic ulcer in the elderly is associated with use of non-steroidal, anti-inflammatory drugs (NSAIDs) and aspirin, presenting a therapeutic dilemma for the treatment of survivors. To determine the longterm morbidity of patients surviving bleeding peptic ulcer and their treatment, with particular reference to NSAID use, this study followed up 487 patients aged over 60 years, who survived an episode of bleeding peptic ulcer in Nottingham during 1986 to 1991. Information was gathered by evaluation of general practitioner and hospital records, scrutiny of death certificates, and postal questionnaire to surviving patients. Of 487 patients surviving a bleeding peptic ulcer, 345 were alive at the follow up, a mean 34.2 months after discharge. Of these 201 (58%) had taken NSAIDs before their ulcer bleed (104 non-aspirin NSAIDs, 77 aspirin, 20 both). Compared with non-users, the patients using NSAIDs at the time of presentation were significantly more likely subsequently to consult their general practitioner with locomotor symptoms (56% v 35%, p < 0.001) and receive further NSAIDs (34% v 13%, p < 0.001), but significantly less likely to consult their general practitioner for dyspepsia (31% v 54%, p < 0.001). Antiulcer drug use was widespread in both groups, with an overall point prevalence of 44%. Seventy five patients received NSAIDs during the follow up period (69% with coprescription of antiulcer drugs, usually H2 antagonists). Recurrent peptic ulcer, ulcer complications, and ulcer related deaths were uncommon. Antiulcer drug use was lower in those with ulcer recurrence compared with the point prevalence in those without (17% v 44%, p < 0.05). Patient questionnaire responses confirmed a high level of locomotor symptoms especially in patients previously admitted with NSAID associated ulcer bleeding. In conclusion, in patients surviving peptic ulcer bleeding, recurrent ulcer complications and death seem to be lower than reported by studies that preceded the advent of antiulcer drugs. It is suggested that this low incidence may be a consequence of their use. Granted the low level of recurrent ulceration and the high level of locomotor symptoms in patients studied, current treatment may unduly emphasise the importance of stopping NSAIDs in this group of patients.
老年消化性溃疡出血与使用非甾体类抗炎药（NSAIDs）和阿司匹林有关，这给幸存者的治疗带来了两难困境。为了确定消化性溃疡出血幸存者的长期发病率及其治疗情况，特别是关于NSAIDs的使用，本研究对1986年至1991年期间在诺丁汉经历过一次消化性溃疡出血且存活的487名60岁以上患者进行了随访。通过评估全科医生和医院记录、审查死亡证明以及向存活患者邮寄问卷来收集信息。在487名消化性溃疡出血幸存者中，345人在随访时仍存活，出院后平均34.2个月。其中201人（58%）在溃疡出血前服用过NSAIDs（104人服用非阿司匹林NSAIDs，77人服用阿司匹林，20人两者都服用）。与未使用者相比，就诊时使用NSAIDs的患者随后因运动症状咨询全科医生的可能性显著更高（56%对35%，p<0.001），并且接受进一步NSAIDs治疗的可能性也显著更高（34%对13%，p<0.001），但因消化不良咨询全科医生的可能性显著更低（31%对54%，p<0.001）。两组中抗溃疡药物的使用都很普遍，总体时点患病率为44%。75名患者在随访期间接受了NSAIDs治疗（69%同时开具了抗溃疡药物，通常是H2拮抗剂）。复发性消化性溃疡、溃疡并发症和溃疡相关死亡并不常见。与无溃疡复发者的时点患病率相比，溃疡复发者的抗溃疡药物使用率更低（17%对44%，p<0.05）。患者问卷回复证实运动症状水平较高，尤其是在先前因NSAID相关溃疡出血入院的患者中。总之，在消化性溃疡出血幸存者中，复发性溃疡并发症和死亡率似乎低于抗溃疡药物出现之前的研究报告。有人认为这种低发病率可能是使用抗溃疡药物的结果。鉴于本研究中患者的溃疡复发率低且运动症状水平高，目前的治疗可能过度强调了在这组患者中停用NSAIDs的重要性。
