Anaesthesia care with and without tracheal intubation during emergency endoscopy for peptic ulcer bleeding: a population-based cohort study.

BACKGROUND: Emergency upper gastrointestinal bleeding is a common condition with high mortality. Most patients undergo oesophagogastroduodenoscopy (OGD), but no universally agreed approach exists to the type of airway management required during the procedure. We aimed to compare anaesthesia care with tracheal intubation (TI group) and without airway instrumentation (monitored anaesthesia care, MAC group) during emergency OGD. METHODS: This was a prospective, nationwide, population-based cohort study during 2006-13. Emergency OGDs performed under anaesthesia care were included. End points were 90 day mortality (primary) and length of stay in hospital (secondary). Associations between exposure and outcomes were assessed in logistic and linear regression models, adjusted for the following potential confounders: shock at admission, level of anaesthetic expertise present, ASA score, Charlson comorbidity index score, BMI, age, sex, alcohol use, referral origin (home or in-hospital), Forrest classification, ulcer localization, and postoperative care. RESULTS: The study group comprised 3580 patients under anaesthesia care: 2101 (59%) for the TI group and 1479 (41%) for the MAC group. During the first 90 days after OGD, 18.9% in the TI group and 18.4% in the MAC group died, crude odds ratio=1.03 [95% confidence interval (CI)=0.87-1.23, P=0.701], adjusted odds ratio=0.95 (95% CI=0.79-1.15, P=0.590). Patients in the TI group stayed slightly longer in hospital [mean 8.16 (95% CI=7.63-8.60) vs 7.63 days (95%=CI 6.92-8.33), P=0.108 in adjusted analysis]. CONCLUSIONS: In this large population-based cohort study, anaesthesia care with TI was not different from anaesthesia care without airway instrumentation in patients undergoing emergency OGD in terms of 90 day mortality and length of hospital stay.

Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults.

BACKGROUND: Peptic ulcer epidemiology has changed considerably within the past century. The aim of this study was to assess the 11-year cumulative incidence of peptic ulcer disease and examine the relationship between ulcer incidence and psychosocial and genetic factors. METHODS: A random sample of 2416 Danish adults with no history of peptic ulcer disease residing in Copenhagen County, Denmark, attended a population-based prospective cohort study in 1983 and 1994. All participants reported whether they had had an ulcer diagnosed within the observation period. Information on socio-economic factors, family history of peptic ulcer disease (PUD) and lifestyle practices was obtained from a questionnaire. Lewis blood group antigens were assessed from blood samples and Helicobacter pylori infection status was determined with an in-house IgG ELISA. RESULTS: The overall 11-year cumulative incidence proportion of PUD was 2.9% (95% CI (2.2; 3.6)), i.e. 1.6% (95% CI (1.1; 2.1)) for duodenal ulcer, and 1.3% (95% CI (0.8; 1.7)) for gastric ulcer. Poor socio-economic status increased the risk of PUD independently of H. pylori infection (odds ratio 2.7, 95% CI (1.1; 6.1)) and accounted for 17% of all ulcer cases. High physical activity at work increased the risk of PUD in people infected with H. pylori (odds ratio 2.6, 95% CI (0.8; 8.0)). Family history of PUD or Lewis blood group antigens did not relate to ulcer incidence. CONCLUSIONS: Poor socio-economic status is an important risk factor for PUD that exerts its effect independently of H. pylori infection. Strenuous work may increase the risk of PUD in people with H. pylori infection. Genetic factors do not influence the risk of PUD in Danish adults.

[The relationship of Helicobacter pylori to iron status--serum ferritin and hemoglobin. A seroepidemiologic survey of 2794 Danes]. / Helicobacter pyloris relation til jernstatus--serumferritin og haemoglobin. En seroepidemiologisk undersøgelse af 2.794 danskere.

We evaluated the influence of Helicobacter pylori (H. pylori) infection assessed by the levels of H. pylori serum IgG-antibodies, on iron status (serum ferritin and haemoglobin) in 2794 Danes (1425 men), aged 30-60 years. The seroprevalence of H. pylori antibodies increased with age (p < 0.01). Median serum ferritin levels were significantly lower in seropositive than in seronegative men and postmenopausal women (men 114 micrograms/L vs. 120 micrograms/L, p = 0.01; premenopausal women 37 micrograms/L vs. 40 micrograms/L, p = 0.13; postmenopausal women 63 micrograms/L vs. 77 micrograms/L, p = 0.02). Seropositive subjects had a higher prevalence of iron deficiency (serum ferritin < 15 micrograms/L) than seronegative subjects. H. pylori infection has a negative influence on iron status. We hypothesize that this may be caused by increased blood losses from the gastric mucosa.

Association of Helicobacter pylori infection with lifestyle, chronic disease, body-indices, and age at menarche in Danish adults.

This study examines the association between lifestyle factors, chronic disease, body-indices, and the seroprevalence of Helicobacter pylori infection in Danish adults. The relationship between age at menarche and H. pylori infection is also assessed. A random sample of 3,608 Danish adults completed a questionnaire about lifestyle factors (smoking habits, alcohol consumption, and coffee and tea intake), doctor diagnosed chronic diseases (heart conditions, diabetes, chronic bronchitis, and hypertension), menarche, and socio-demographic factors. A total of 2,913 participants were eligible for the present study. Electrocardiographs were recorded and blood pressure and serum lipid levels (HDL cholesterol, triglyceride, and cholesterol) were measured. Height and weight were determined and body mass index (BMI) calculated. Sera were analysed with an enzyme-linked immunosorbent assay for the presence of H. pylori specific IgG antibodies. The seroprevalence of H. pylori infection was associated with weekly alcohol intake > or = 6 drinks (odds ratio 0.7, 95% confidence interval 0.6-0.9) due to a low rate of H. pylori infection among wine drinkers (odds ratio 0.6, 95% confidence interval 0.5-0.7). No associations were found with smoking habits or serum lipids. People with upper quartile BMI (> or = 26.8 kg/m2) were more likely to be seropositive for antibodies to H. pylori (odds ratio 1.6, 95% confidence interval 1.1-2.4). Chronic bronchitis (odds ratio 1.6, 95% confidence interval 1.1-2.5) and unspecified heart condition (odds ratio 2.0, 95% confidence interval 1.1-3.3) was more often seen in IgG seropositive women than in uninfected women. The likelihood of being seropositive for IgG antibodies to H. pylori increased with age at menarche (odds ratio per year 1.10, 95% confidence interval 1.02-1.19). Previously reported associations with age and socioeconomic status were confirmed. We conclude that wine drinking is associated with lower rates of H. pylori infection in Danish adults. The seroprevalence of H. pylori infection is increased in people with high BMI. H. pylori infection may relate to a history of late menarche and chronic bronchitis in Danish women.

[Helicobacter pylori infection and socioeconomic factors among adult Danes]. / Helicobacter pylori-infektion og socioøkonomiske faktorer blandt voksne danskere.

The aim of this study was to examine the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. IgG, IgM, and IgA antibodies against Helicobacter pylori were measured by ELISA techniques in sera obtained from a random sample of 3589 Danes participating in a population study. Poor social status (odds ratio 2.2 [1.7-3.0]), short duration of schooling (odds ratio 2.0 [1.3-2.5]), lack of vocational training/education (odds ratio 1.4 [1.2-1.7]), unskilled work (odds ratio 1.7 [1.2-2.5]), and high work-related energy expenditure (odds ratio 1.4 [1.1-1.9]) increased the likelihood of chronic Helicobacter pylori infection. Chronic Helicobacter pylori infection was frequently found in people with a history of living abroad. Increased levels solely of IgM antibodies to H. pylori, interpreted as a sign of acute infection, were found more often in people who were divorced (odds ratio 2.3 [1.2-4.4]) or unmarried (odds ratio 2.0 [1.1-3.8]) and in people who worked long hours (odds ratio 2.0 [1.1-4.0]). In conclusion, educational and occupational factors relate to the likelihood of chronic Helicobacter pylori infection in adults. The rate of acute Helicobacter pylori infection is probably increased in single adults.

Socioeconomic factors in Helicobacter pylori infection among Danish adults.

OBJECTIVES: This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. METHODS: Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. RESULTS: Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). CONCLUSIONS: Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals.

Seroprevalence of immunoglobulin G, M, and A antibodies to Helicobacter pylori in an unselected Danish population.

The seroprevalences of increased levels of immunoglobulin G (lgG), M (lgM), and A (lgA) antibodies to Helicobacter pylori were assessed by enzyme-linked immunosorbent assay techniques in 3,589 Danes who participated in a population study in Copenhagen County in 1982. A total of 33.9% of the study population had one or more classes of increased antibodies to H. pylori. Increased levels of lgG, lgM, and lgA antibodies to H. pylori were seen in 25.9% (95% confidence interval (Cl) 24.5-27.3), 4.5% (95% Cl 2.2-7.0), and 12.0% (95% Cl 10.9-13.1) of the participants, respectively. Women were significantly more likely than men to be seropositive for lgM antibodies (Mantel-Haenszel summary odds ratio = 1.85, 95% Cl 1.34-2.57). Seropositivity for lgM antibodies to H. pylori was found less often with increasing age. An lgG antibody response was not seen in 23.7% of cases with overall increased antibodies to H. pylori. Increased levels of lgG or lgA antibodies were more frequent in people with a history of peptic ulcer disease. Seroprevalences of increased H. pylori antibodies are high in unselected populations. Primary H. pylori infections are contracted at all ages, but infection rates decline with age. Inclusion of measurements of lgA and lgM antibody levels in future screening for H. pylori may improve the diagnostic sensitivity of serologic analyses.

Prevalence and incidence of peptic ulcer disease in a Danish County--a prospective cohort study.

Peptic ulcer prevalence and five year incidence were assessed in a sex and age stratified population sample of 3608 Danish subjects aged 30-60 years. Statements of peptic ulcer disease obtained from questionnaires were scrutinised by reviewing medical records. Life time ulcer prevalence (95% confidence intervals) was 5.6 (4.9-6.4) per cent. Male to female prevalence ratio was 2.2:1, and duodenal to gastric ulcer prevalence ratio was 3.8:1. Thirty two participants with no previous history of peptic ulceration developed an ulcer within the observation period resulting in a five year ulcer incidence of 11.3 (7.4-15.2) per 1000 persons at risk with no demonstrable sex difference. The prevalence of duodenal ulcer has declined in Denmark whereas gastric ulcer prevalence in men has increased slightly. A decline in male duodenal ulcer incidence has probably contributed to the low male to female ulcer incidence ratio, implying that women today incur the same risk of developing an ulcer as men. If such trends continue, they will bring about a new era in ulcer epidemiology characterised by equal incidence in men and women and an even distribution of lesions in the stomach and duodenum.

[Occurrence of lung cancer in Denmark 1943-1986. Reliability of the cancer registry]. / Forekomsten af lungekraeft i Danmark 1943-1986. Cancerregisterets pålidelighed.

A rise in the number of adenocarcinomas of the lung and a fall in squamous cell carcinomas are seen in Denmark since 1978; a change based on a growing number of lung cancers among women with an excess of adenocarcinomas. A fall in the frequency of autopsies in Denmark will entail the loss of an essential control of the quality of diagnosis of lung cancer, primary or secondary, and make future descriptive studies difficult to interpret. The validity of morphologic diagnosis of lung cancer as recorded by the Danish Cancer Registry during 1943-1986 was assessed. We extracted a stratified random sample of 5% of all recorded cases prior to 1978, these were then recorded according to the ICD-O classification. Cases after 1978 were originally coded in the Registry according to ICD-O, here we checked the coding against the original reports. The information on morphology prior to 1978 was too inprecise to merit evaluation of trends and proportionate distributions by morphology. After 1978 data was adequate, and after 1983 very precise.