Abstract
Two hundred and thirty five consecutive patients with a life threatening complication of peptic ulceration, who either died or required emergency surgery, have been studied over a 36 month period. Seventy eight of these high risk patients died; 25 at home, 19 in hospital without surgery and 34 postoperatively. Ninety eight patients had bleeding ulcers, 132 perforated ulcers and five had both bleeding and perforated ulcers. One hundred and forty one of these 235 patients (60%) were taking a non-steroidal anti-inflammatory drugs (NSAID) and the individual agents have been listed. The overall incidence of NSAID use in a hospital control group was 9.9%. The first sign of an ulcer was a life threatening complication in 58.2% of patients taking a NSAID. Nearly 80% of all ulcer related deaths occurred in patients using an anti-inflammatory agent. Patients using these drugs were older, with more pre-existing medical conditions and had larger ulcers than those not taking NSAIDs. The mortality associated with a peptic ulcer complication in patients taking a NSAID was more than twice that in patients with no such drug history. There appears to be a relationship between the development of a life threatening complication of peptic ulceration and NSAID ingestion. Much of the associated mortality and morbidity may be potentially avoidable.
Full text
PDF





Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- A statement on breast health and mammography. Med J Aust. 1985 Jan 7;142(1):59–60. [PubMed] [Google Scholar]
- Bardhan K. D. Refractory duodenal ulcer. Gut. 1984 Jul;25(7):711–717. doi: 10.1136/gut.25.7.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Berry A. R., Collin J., Frostick S. P., Dudley N. E., Morris P. J. Upper gastrointestinal haemorrhage in Oxford. A prospective study. J R Coll Surg Edinb. 1984 May;29(3):134–138. [PubMed] [Google Scholar]
- Bjarnason I., Williams P., So A., Zanelli G. D., Levi A. J., Gumpel J. M., Peters T. J., Ansell B. Intestinal permeability and inflammation in rheumatoid arthritis: effects of non-steroidal anti-inflammatory drugs. Lancet. 1984 Nov 24;2(8413):1171–1174. doi: 10.1016/s0140-6736(84)92739-9. [DOI] [PubMed] [Google Scholar]
- Bonnevie O. Survival in peptic ulcer. Gastroenterology. 1978 Dec;75(6):1055–1060. [PubMed] [Google Scholar]
- Coggon D., Lambert P., Langman M. J. 20 years of hospital admissions for peptic ulcer in England and Wales. Lancet. 1981 Jun 13;1(8233):1302–1304. doi: 10.1016/s0140-6736(81)92470-3. [DOI] [PubMed] [Google Scholar]
- Collier D. S., Pain J. A. Non-steroidal anti-inflammatory drugs and peptic ulcer perforation. Gut. 1985 Apr;26(4):359–363. doi: 10.1136/gut.26.4.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davenport H. W. The gastric mucosal barrier. Digestion. 1972;5(3):162–165. doi: 10.1159/000197189. [DOI] [PubMed] [Google Scholar]
- Day T. K. Intestinal perforation associated with osmotic slow release indomethacin capsules. Br Med J (Clin Res Ed) 1983 Dec 3;287(6406):1671–1672. doi: 10.1136/bmj.287.6406.1671-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dronfield M. W., Atkinson M., Langman M. J. Effect of different operation policies on mortality from bleeding peptic ulcer. Lancet. 1979 May 26;1(8126):1126–1128. doi: 10.1016/s0140-6736(79)91803-8. [DOI] [PubMed] [Google Scholar]
- Fineberg H. V., Pearlman L. A. Surgical treatment of peptic ulcer in the United States. Trends before and after the introduction of cimetidine. Lancet. 1981 Jun 13;1(8233):1305–1307. doi: 10.1016/s0140-6736(81)92471-5. [DOI] [PubMed] [Google Scholar]
- Hawkey C. J., Rampton D. S. Prostaglandins and the gastrointestinal mucosa: are they important in its function, disease, or treatment? Gastroenterology. 1985 Nov;89(5):1162–1188. doi: 10.1016/0016-5085(85)90225-2. [DOI] [PubMed] [Google Scholar]
- Hirschowitz B. I. Natural history of duodenal ulcer. Gastroenterology. 1983 Oct;85(4):967–970. [PubMed] [Google Scholar]
- Hunt P. S., Hansky J., Korman M. G. Mortality in patients with haematemesis and melaena: a prospective study. Br Med J. 1979 May 12;1(6173):1238–1240. doi: 10.1136/bmj.1.6173.1238. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jacyna M. R., Shepherd A. N. Perforated ulcer in the elderly. Lancet. 1985 Dec 7;2(8467):1309–1309. doi: 10.1016/s0140-6736(85)91595-8. [DOI] [PubMed] [Google Scholar]
- Jorgensen T. G. Drug consumption before perforation of peptic ulcer. Br J Surg. 1977 Apr;64(4):247–249. doi: 10.1002/bjs.1800640406. [DOI] [PubMed] [Google Scholar]
- Kurata J. H., Elashoff J. D., Grossman M. I. Inadequacy of the literature on the relationship between drugs, ulcers, and gastrointestinal bleeding. Gastroenterology. 1982 Feb;82(2):373–376. [PubMed] [Google Scholar]
- Langman M. J., Morgan L., Worrall A. Use of anti-inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J (Clin Res Ed) 1985 Feb 2;290(6465):347–349. doi: 10.1136/bmj.290.6465.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Brien J. D., Burnham W. R. Bleeding from peptic ulcers and use of non-steroidal anti-inflammatory drugs in the Romford area. Br Med J (Clin Res Ed) 1985 Dec 7;291(6509):1609–1610. doi: 10.1136/bmj.291.6509.1609. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pemberton R. E., Strand L. J. A review of upper-gastrointestinal effects of the newer nonsteroidal antiinflammatory agents. Dig Dis Sci. 1979 Jan;24(1):53–64. doi: 10.1007/BF01297239. [DOI] [PubMed] [Google Scholar]
- Somerville K., Faulkner G., Langman M. Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer. Lancet. 1986 Mar 1;1(8479):462–464. doi: 10.1016/s0140-6736(86)92927-2. [DOI] [PubMed] [Google Scholar]
- Taylor T. V. Deaths from peptic ulceration. Br Med J (Clin Res Ed) 1985 Sep 7;291(6496):653–654. doi: 10.1136/bmj.291.6496.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Walt R., Katschinski B., Logan R., Ashley J., Langman M. Rising frequency of ulcer perforation in elderly people in the United Kingdom. Lancet. 1986 Mar 1;1(8479):489–492. doi: 10.1016/s0140-6736(86)92940-5. [DOI] [PubMed] [Google Scholar]
- Watkins R. M., Dennison A. R., Collin J. What has happened to perforated peptic ulcer? Br J Surg. 1984 Oct;71(10):774–776. doi: 10.1002/bjs.1800711012. [DOI] [PubMed] [Google Scholar]
