Key result
Population PPI prescriptions linked to lower UGIB rates, while aspirin tracks with higher overall GIB.
Why the study?
The trends of gastrointestinal bleeding are evolving with increasing use of aspirin, proton pump inhibitors, and Helicobacter pylori eradication therapies, but their effects on GIB incidences are unclear.
How do population-level prescriptions of aspirin, PPIs, and H. pylori eradication therapies affect the incidence of upper and lower gastrointestinal bleeding?
Observational
Yes
How do population-level prescriptions of aspirin, PPIs, and H. pylori eradication therapies affect the incidence of upper and lower gastrointestinal bleeding?
Effect estimate: coefficient -4.58 (95% CI -5.69 to -3.47)
Population-level increases in aspirin prescriptions are associated with rising lower gastrointestinal bleeding, while increased PPI use is associated with declining upper gastrointestinal bleeding.
LGIB surpassing UGIB in elderly linked to rising aspirin use; extends observational trends but leaves causal effects on future GIB open.
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.
No takes yet. Share an insight, caveat, or question.
Guo et al. (2021) conducted an observational in Gastrointestinal bleeding. Population prescriptions of aspirin, proton pump inhibitors (PPIs), and Helicobacter pylori eradication therapies was evaluated on Incidence of upper gastrointestinal bleeding (UGIB) (coefficient -4.58, 95% CI -5.69 to -3.47). Population prescriptions of PPIs were negatively associated with upper gastrointestinal bleeding (coefficient -4.58; 95% CI -5.69 to -3.47), whereas aspirin increased both upper and lower GIB.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: