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Sunday, 17 March, 2002, 00:25 GMT
Rise in stomach ulcer bleeding
gastric ulcer
Several factors may influence the formation of gastric ulcers
There has been a surge in bleeding stomach ulcers among elderly patients which appears to correspond with the increase in aspirin use.

Aspirin, and other anti-inflammatory drugs have been credited with saving many thousands of lives from heart attacks and strokes.

However, it was warned that their action could render some patients more vulnerable to gastric bleeding.

A study published in the journal Gut points out a marked rise in cases of these over recent years.

It contrasts this with the vast increase in prescribing of not only aspirin and other anti-inflammatories, but also anti-depressants in the same class as Prozac.

The combinations of drugs taken, particularly by the elderly is a big problem

Dr Martin Sarner

They found the rise in the rate of bleeding from stomach ulcers corresponds with higher numbers of prescriptions given out for heart disease tablets and some types of anti-depressants.

The researchers stress that more study should be carried out to find if there is a definite link between the two - particularly for older patients.

The researchers, led by Dr Azeem Majeed, of the University College London, studied hospital admissions for bleeding ulcers over a 10-year period from 1989-1999.


The death rate from peptic ulcers - found in the lining of the stomach or in the duodenum - is low and most deaths occur through complications in some elderly patients.

It means that the treatment given to them is significant, say the researchers.

The researchers also looked at the number of prescriptions for both ulcer healing drugs and those connected with gastrointestinal bleeding (bleeding from stomach ulcers).

Although heart disease tablets thin the blood this could lead to increased bleeding from stomach ulcers.

Prescriptions were also examined for new generation anti-depressants such as Prozac.

A link has already been put forward between these anti-depressants known as SSRIs and upper gastrointestinal bleeding, the report states.

The study results showed that deaths from peptic ulcers continued to fall in all age groups, except women over 65. There was a similar rise in admissions for bleeding peptic ulcers among the elderly

Almost doubled

In the over 74 age group admissions for peptic and gastric ulcers rose by 29% for women and 40% for men with similar increases for gastrointestinal bleeding.

For duodenal ulcers admissions the increase was even higher - a third among elderly women and almost double (49%) for men.

Internal bleeding accounted for most of this.

Among those aged between 64 and 74, rates again almost doubled.

'More work needed'

The researchers looked at ulcer-healing drugs and found they had increased two and a half times between 1990 and 1999.

And prescriptions for aspirin rose by 460%, for blood thinners (anticoagulants) by 200%, and NSAIDs by 13%.

But prescriptions for the newer and more expensive ulcer healing drugs - proton pump inhibitors - rose by over 5000%.

And by the end of the 1990s, 15 times as many new generation anti-depressants were being prescribed as when they were first introduced.

The study's authors say: "Further work is needed to establish ... the relative contribution of various drugs, both ulcer causing and ulcer healing, to the pattern of peptic ulcer disease in our population."

Dr Martin Sarner, a consultant physician at University College Hospital in London said the research was "very positive".

He said: "The combinations of drugs taken, particularly by the elderly is a big problem. We are talking about an increasingly medicated population who are prone to bleeding and may well be taking anti-coagulants.

"It can be hard for a practitioner to know what its best to prescribe."

He too said further studies would be important to look at what dosage of blood thinners is advisable if patients were taking other drugs.

The research is reported in Thursday's edition of Gut medical journal.

See also:

11 Jan 02 | Health
Aspirin 'could save thousands'
17 Mar 00 | C-D
Oesophageal cancer
19 Aug 01 | Health
Herbal 'heartburn' treatment
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