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

Chuan-Guo Guo; Feifei Zhang; Joseph T Wu; Ka-Shing Cheung; Bofei Li; Simon Y K Law; Wai K Leung

doi:10.1002/ueg2.12067

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

United European Gastroenterol J. 2021 Jun;9(5):543-551. doi: 10.1002/ueg2.12067. Epub 2021 May 6.

Authors

Chuan-Guo Guo¹, Feifei Zhang², Joseph T Wu³, Ka-Shing Cheung¹, Bofei Li⁴, Simon Y K Law⁴, Wai K Leung¹

Affiliations

¹ Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
² Usher Institute, University of Edinburgh, Edinburgh, UK.
³ School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
⁴ Division of Esophageal and Upper Gastrointestinal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.

Abstract

Background: 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.

Keywords: aspirin; epidemiology; gastrointestinal bleeding; proton pump inhibitors; time trend.

MeSH terms

Aged
Aged, 80 and over
Anti-Bacterial Agents / adverse effects
Anti-Inflammatory Agents, Non-Steroidal / adverse effects
Anticoagulants / adverse effects
Aspirin / adverse effects
Confidence Intervals
Female
Gastrointestinal Hemorrhage / chemically induced*
Gastrointestinal Hemorrhage / epidemiology*
Helicobacter Infections / drug therapy
Helicobacter pylori
Hong Kong / epidemiology
Hospitalization / trends*
Humans
Incidence
Male
Middle Aged
Platelet Aggregation Inhibitors / adverse effects
Proton Pump Inhibitors / adverse effects

Substances

Anti-Bacterial Agents
Anti-Inflammatory Agents, Non-Steroidal
Anticoagulants
Platelet Aggregation Inhibitors
Proton Pump Inhibitors
Aspirin