Acute upper gastrointestinal bleeding in the Amsterdam area: incidence, diagnosis, and clinical outcome.

OBJECTIVES: In the United States of America and the United Kingdom several epidemiological upper gastrointestinal bleeding (UGIB) surveys have been done. However, information about the current epidemiology of acute UGIB in continental Western Europe is sparse. METHODS: From July of 1993 to July of 1994, 951 patients with acute UGIB were prospectively included in 12 hospitals in the Amsterdam area. Data were collected prospectively with a standard questionnaire and included demographic as well as specific data relating to UGIB. RESULTS: The overall incidence was 45 per 100,000 persons/yr. Patients had an advanced age (median, 71 yr), and shock was found in 63%. Coexisting illnesses were present in 85%. Twenty percent had a history of previous ulcer disease, of whom 33% used acid suppressive therapy. Endoscopy was performed within 24 h in 78%, and in 42% a gastroduodenal ulcer was found. In 24%, no diagnosis could be made at the initial endoscopy, in these patients endoscopy was done significantly later than in those in whom a diagnosis was readily made. Rebleeding occurred in 16.4%, and 7% had surgery. Mortality rate was 13.9%, which was considered in one-third to be directly related to the bleeding. CONCLUSIONS: The incidence and diagnostic profile of UGIB is similar to other large European studies, but different from those for the United States. Bleeding could perhaps have been prevented in the patients with a history of previous ulcer disease. The 24-h endoscopy service was not as fast, accurate, and widespread as we assumed. Mortality seems to be more related to advanced age, shock, and coexisting illnesses.

[Upper digestive tract hemorrhage; an assessment in the Amsterdam region]. / Bloedingen hoog in de tractus digestivus; een inventarisatie in de regio Amsterdam.

OBJECTIVE: To inventory diagnostic and therapeutic strategies and the value of endoscopy in upper gastrointestinal haemorrhage in Amsterdam and environs. DESIGN: Descriptive. SETTING: Eight hospitals in and around Amsterdam. METHOD: For 3 months all patients with upper gastrointestinal haemorrhage were recorded. The total group consisted of 132 patients. RESULTS: The group included 81 men and 51 women, the mean age was 63 years. Prior to the symptoms, 44% had used acetylsalicylic acid, non-steroidal anti-inflammatory drugs or oral anticoagulants. Diagnostic endoscopy was performed in 85% within 24 hours. The most frequent diagnosis was ulcerative disease (48%). Medication was given to 86% of the patients, 20% underwent endoscopic (injection) therapy and only 17% were operated on. Recurrent haemorrhage was seen in 24%, overall mortality was 6%. CONCLUSION: Ulcerative disease is still the most common cause of upper gastrointestinal haemorrhage. Medication is still more or less routinely administered, despite lacking proof of efficacy.

Effect of long-term treatment with omeprazole on serum gastrin and serum group A and C pepsinogens in patients with reflux esophagitis.

Twenty-nine nongastrectomized and three partially gastrectomized patients with chronic reflux esophagitis resistant to 12 weeks' treatment with histamine H2-receptor antagonists were treated with a daily oral dose of 20-40 mg of omeprazole for 12-30 months. Basal serum gastrin, serum pepsinogen A, and serum pepsinogen C concentrations were monitored at regular intervals. Serum gastrin levels significantly (P less than 0.01) increased threefold to fourfold during the first 1-2 months of the study when all patients ingested 40 mg of omeprazole daily. Dose reduction to 20 mg did not significantly decrease gastrin levels. Serum gastrin levels showed a trend to further increase after the first 3 months of treatment, reaching statistically significant differences for values from the 3-12-month period (P less than 0.05) and from the 3-24-month period (P less than 0.005). Women and patients with high basal serum gastrin levels before omeprazole treatment were more likely to achieve higher serum gastrin levels during omeprazole treatment. Serum pepsinogen A and C levels were significantly (P less than 0.01) increased at all time intervals during long-term treatment with omeprazole. No significant tendency toward higher serum pepsinogen C levels in time was observed. However, serum pepsinogen A levels and the ratio of pepsinogen A to pepsinogen C further increased significantly (P less than or equal to 0.05) during the initial 3-12-month period. However, this trend was not observed anymore afterward. Antrectomized patients did not show increases in serum gastrin and serum pepsinogen A and C levels, suggesting that hypergastrinemia may be involved in the observed hyperpepsinogenemia.

Efficacy of the H+/K+-adenosine triphosphatase inhibitor omeprazole in peptic ulcer.

In duodenal ulcer studies comprising more than 2,000 patients the efficacy of omeprazole in doses of 20-40 mg once daily has been compared with the recommended doses of the H2-receptor antagonists cimetidine and ranitidine. At 2 weeks the differences in healing rates in favour of omeprazole were 12-33%; while they were somewhat lower at 4 weeks, ranging from 4 to 20%. In most studies the difference in healing rate was statistically significant. In some studies pain relief at 2 weeks was more pronounced on omeprazole. In three gastric ulcer studies omeprazole in doses of 20 or 40 mg once daily has been compared with ranitidine 150 mg twice daily. Healing rates on omeprazole were significantly greater in 2 of the 3 studies. Pain relief was faster on the higher dose of omeprazole. In prepyloric gastric ulcer the healing rate at 2 weeks was not significantly greater on 20 or 40 mg omeprazole than on ranitidine, while in another study the healing rate was significantly greater on 30 mg omeprazole as compared with cimetidine. In the first week of treatment more patients on omeprazole became free of pain in the latter study. The relapse rate after stopping therapy was similar for omeprazole and the H2-receptor antagonists independent of the type of ulcer. In conclusion, omeprazole heals ulcers faster than the recommended doses of H2-receptor antagonist. The difference in healing rate is more pronounced halfway than at the end of the treatment course.