The Pharmaceutical Journal
Vol 268 No 7190 p385-391
23 March 2002

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Gut Online (gut.bmjjournals.com)
The Lancet (www.thelancet.com)

Elderly patients suffer more bleeding ulcers now because of drug changes

Hospital admission rates for bleeding peptic ulcers among elderly patients increased throughout the past decade despite changes in drug treatment, a study published in Gut shows.

Researchers looked at the numbers of hospital admissions and deaths in England attributable to peptic ulcers from 1989 to 1998. They also analysed information on the number of prescriptions for ulcer-healing drugs and those drugs associated with an increased risk of gastrointestinal bleeding (non-steroidal anti-inflammatory drugs [NSAIDs], anticoagulants and selective serotonin reuptake inhibitors [SSRIs]).

The researchers, from St George's Hospital, London, found that the number of deaths from peptic ulcers fell across all age groups, except among women over the age of 65 years in whom the rate stabilised. Hospital admission rates for bleeding peptic ulcers among young people also fell. But rates for bleeding peptic ulcers among the elderly rose, particularly for bleeding associated with duodenal ulcers.

For those aged 74 years and over, admissions for peptic and gastric ulcers rose by 29 per cent in women and 40 per cent in men, with similar increases in admissions for gastrointestinal bleeding. For duodenal ulcers, admissions rose by a third among elderly women and almost doubled among elderly men.

Despite these rises, the researchers found that the number of prescriptions for ulcer-healing drugs increased by two and a half times between 1990 and 1999. However, prescriptions for aspirin also rose by 460 per cent, for anticoagulants by 200 per cent, and for other NSAIDs by 13 per cent.

"Our finding of a decrease in hospital admissions for peptic ulcer among younger individuals but an increasing frequency among older individuals would be consistent with ... a decline in Helicobacter pylori infection concurrently with an increase in the use of ulcerogenic drugs," the researchers say. They qualify their explanation by saying that younger people would benefit from a reduction in H pylori incidence in the community and that older people would be more likely to receive NSAIDs, aspirin and antidepressant drugs (2002;50:460).