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Admission rates for peptic ulcer in the trent region, UK, 1972--2000. changing pattern, a changing disease?
K D Bardhan1, M Williamson, C Royston
1Rotherham General Hospital NHS Trust, Moorgate Road, Rotherham S60 2UD, UK. bardhan.sec@rothgen.nhs.uk
Insights
Emergency admissions for peptic ulcers remained stable, but elective surgeries significantly decreased over three decades. This suggests modern treatments impact surgical rates more than emergency admissions for conditions like bleeding or perforation.
Area of Science:
- Gastroenterology
- Epidemiology
- Health Services Research
Background:
- Peptic ulcer disease (PUD) management has evolved with modern medical advancements.
- The impact of these advancements on PUD prevalence and severity requires investigation.
Purpose of the Study:
- To analyze trends in hospital admission rates for duodenal and gastric ulcers.
- To compare emergency and elective surgery admission rates before and after new therapeutic interventions.
Main Methods:
- Utilized computerized patient data from Trent Regional Health Authority (1972-2000).
- Analyzed admission rates per million population using ICD8-10 codes.
- Correlated admission trends with drug expenditure data.
Main Results:
- Emergency admission rates for PUD showed little overall change, with shifts between age groups.
- Hemorrhage was the most frequent emergency admission reason for both duodenal and gastric ulcers.
- Elective surgery admissions for PUD have dramatically declined, preceding modern treatment introductions.
Conclusions:
- Emergency PUD admissions for complications or severe pain have remained relatively stable over 30 years.
- Elective surgery for PUD has significantly decreased, attributed to treatment advances and potential changes in disease natural history.
Background And Aim:
Peptic ulcer disease is believed to be less common and less severe as a result of modern medical treatment. We therefore examined changes in the admission rates for patients with duodenal ulcer and gastric ulcer, both emergency (for haemorrhage, perforation or severe pain) and for elective surgery, before and since the introduction of the new advances in therapy. These admission indices reflect disease prevalence and severity.
Patients And Methods:
We identified admission rates during 1972--2000 within the Trent Regional Health Authority, UK (population 4.7 million), from computerised patient information using diagnostic search codes ICD8-10 and expressed as rates per million resident population. Drug expenditure details were obtained from the Department of Health.
Results:
Emergency admission rates as a whole changed little, a decline in the young being offset by an increase in the elderly. Haemorrhage was the most common reason (approximately 115 per million for duodenal ulcer and 87 for gastric ulcer) throughout [compared with perforation (80 and 21) and pain (90 and 68)]. In contrast, elective surgery has almost disappeared; this reduction began before the introduction of modern treatment.
Conclusion:
Emergency admission rates for duodenal and gastric ulcer for complications or severe pain have fluctuated over the last three decades but with little overall change. In contrast, elective surgery has declined dramatically, as a result of advances in treatment but also from changes in the natural history.
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