Advances in Ulcer Management Cut Hospitalizations

COPENHAGEN — Each of the two “major revolutions” in managing gastric ulcers that occurred during the past decade produced clear drops in hospitalization rates in the United States.

The 1995 onset of routine eradication of Helicobacter pylori infection and the 1999 introduction of selective cyclooxygenase-2 inhibitors were associated with sharp falls in the number of patients hospitalized for complicated gastric ulcers, duodenal ulcers, or peptic ulcer disease, Gurkipal Singh, M.D., said at the annual United European Gastroenterology Week.

He and his associates analyzed data collected by the National Inpatient Sample, a stratified, random sample of all community hospitals in the United States that represents about 85% of all hospitalizations.

Data were assessed for 1988–2003, a period of more than 490 million hospitalizations that involved 3.6 billion patient-years of observations. Almost 2.2 million of the hospitalizations were for a primary diagnosis of complicated gastric ulcer, duodenal ulcer, or peptic ulcer disease.

The period studied included striking increases in the use of NSAIDs, and in the use of proton pump inhibitors (PPIs), which play a key role in the regimens used to eradicate H. pylori. Prescriptions for NSAIDs rose from 68 million in 1990 to 113 million in 2001. Prescriptions for PPIs jumped from 4 million in 1992 to 74 million 9 years later. Prescription data were obtained from IMS Health, a company that collects information on the pharmaceutical industry.

The rate of hospitalization for complicated ulcer disorders per 100,000 NSAID prescriptions steadily dropped throughout the period 1992–2001, falling from 241.5/100,000 scripts in 1992 to 123.8/100,000 in 2001. But the overall downward trend was punctuated by two sharp drops in the hospitalization ratio.

In 1995, the ratio of ulcer hospitalizations to 100,000 NSAID prescriptions fell by 11%, probably reflecting the 1994 recommendation by a consensus conference to eradicate all diagnosed infections by H. pylori, said Dr. Singh, a physician who specialized in clinical outcomes research at Stanford (Calif.) University.

And in 1999 the ratio dropped by 22% compared with the prior year, likely a consequence of the introduction of selective COX-2 inhibitors in the United States in 1998, Dr. Singh said.