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

• Published in: United European gastroenterology journal 2021-06, Vol.9 (5), p.543-551
• Main Authors: Guo, Chuan‐Guo, Zhang, Feifei, Wu, Joseph T., Cheung, Ka‐Shing, Li, Bofei, Law, Simon Y. K., Leung, Wai K.
• Format: Article
• Language: English
• Subjects: Age groups; Anticoagulants; Aspirin; Emergency medical care; epidemiology; gastrointestinal bleeding; Hospitalization; Nonsteroidal anti-inflammatory drugs; Patients; Population; Prescription drugs; proton pump inhibitors; time trend; Trends
• ISSN: 2050-6406; 2050-6414
• DOI: 10.1002/ueg2.12067

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. Key summary Summarize the established knowledge on this subject With increasing use of proton pump inhibitors (PPIs) and Helicobacter pylori eradication therapy, the incidences of upper gastrointestinal bleeding (UGIB) are declining. The increasing use of antiplatelets and anticoagulants, however, increases the risk of both UGIB and lower gastrointestinal bleeding (LGIB). The dynamic contribution of these factors on the incidences of UGIB and LGIB at population level remains uncertain. What are the significa