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Article: Divergent trends of hospitalizations for upper and lower gastrointestinal bleeding based on population prescriptions of aspirin, proton pump inhibitors and Helicobacter pylori eradication therapy

TitleDivergent trends of hospitalizations for upper and lower gastrointestinal bleeding based on population prescriptions of aspirin, proton pump inhibitors and Helicobacter pylori eradication therapy
Authors
Keywordsaspirin
epidemiology
gastrointestinal bleeding
proton pump inhibitors
time trend
Issue Date2021
PublisherJohn Wiley & Sons Ltd. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/20506414
Citation
United European Gastroenterology Journal, 2021, v. 9 n. 5, p. 543-551 How to Cite?
AbstractBackground: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.
DescriptionHybrid open access
Persistent Identifierhttp://hdl.handle.net/10722/299702
ISSN
2023 Impact Factor: 5.8
2023 SCImago Journal Rankings: 1.612
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorGUO, CG-
dc.contributor.authorZHANG, F-
dc.contributor.authorWu, JT-
dc.contributor.authorCheung, KS-
dc.contributor.authorLi, B-
dc.contributor.authorLaw, SYK-
dc.contributor.authorLeung, WK-
dc.date.accessioned2021-05-26T03:27:51Z-
dc.date.available2021-05-26T03:27:51Z-
dc.date.issued2021-
dc.identifier.citationUnited European Gastroenterology Journal, 2021, v. 9 n. 5, p. 543-551-
dc.identifier.issn2050-6406-
dc.identifier.urihttp://hdl.handle.net/10722/299702-
dc.descriptionHybrid open access-
dc.description.abstractBackground: 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. Objective: 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. Methods: 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. Results: 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. Conclusions: 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.-
dc.languageeng-
dc.publisherJohn Wiley & Sons Ltd. The Journal's web site is located at https://onlinelibrary.wiley.com/journal/20506414-
dc.relation.ispartofUnited European Gastroenterology Journal-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectaspirin-
dc.subjectepidemiology-
dc.subjectgastrointestinal bleeding-
dc.subjectproton pump inhibitors-
dc.subjecttime trend-
dc.titleDivergent trends of hospitalizations for upper and lower gastrointestinal bleeding based on population prescriptions of aspirin, proton pump inhibitors and Helicobacter pylori eradication therapy-
dc.typeArticle-
dc.identifier.emailWu, JT: joewu@hku.hk-
dc.identifier.emailCheung, KS: cks634@hku.hk-
dc.identifier.emailLaw, SYK: slaw@hku.hk-
dc.identifier.emailLeung, WK: waikleung@hku.hk-
dc.identifier.authorityWu, JT=rp00517-
dc.identifier.authorityCheung, KS=rp02532-
dc.identifier.authorityLaw, SYK=rp00437-
dc.identifier.authorityLeung, WK=rp01479-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1002/ueg2.12067-
dc.identifier.pmid33956403-
dc.identifier.pmcidPMC8259432-
dc.identifier.scopuseid_2-s2.0-85105195898-
dc.identifier.hkuros322500-
dc.identifier.volume9-
dc.identifier.issue5-
dc.identifier.spage543-
dc.identifier.epage551-
dc.identifier.isiWOS:000647594500001-
dc.publisher.placeUnited Kingdom-

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