A Study On The Factors Associated With The Recurrence Of Peptic Ulcer Disease In Old People

BackgroundPeptic ulcer disease (PUD) is a common disease of old people. PUD incidence increases with age. Older individuals are different from younger individuals in many aspects, such as gastric acid secretion and feedback regulating mechanisms, medications, Helicobacter pylori (Hp) infection traits, gastrointestinal motility or visceral sensation. In the elderly patient with PUD, symptom presentation may be subtle or atypical, resulting in a delayed diagnosis. Owing to combined morbidity and advanced age, complications, morbidity and mortality is increasing. In addition, the probability of older individuals taking drugs that damage upper digestive tract mucosal is increasing. Therefore, elder’s PUD is difficult to be cured and easy to recur.Objective1. to observe the morbidity of elder’s PUD in geriatrics department of Huadong hospital in 2006.2. to observe the therapy, follow-up and recurrence of these patients in the next 3 years.3. to find the correlation factors of elder’s PUD recurrence in Huadong hospital.4. to provide the evidence to evaluate the anti-recurrence therapy of elder’s PUD and find out the space to improve.MethodsWe collect the history of the patients who were diagnosing with peptic ulcer by endoscopy examination in geriatrics department of Huadong hospital in 2006. We analyse their therapy and medication in our hospital and investigate their medication and recurrence between 2007 and 2009. Set up a database and analyse the data by SPSS 13.0.Results1. A total of 169 patients are included. The number of female is 20(11.2%) when male is 149(88.2%). Male with female is about 7.45:1. The median age of total patients is 79 years old, the patients between 80 and 89 years old is 46.7%.2. According to the morbidity and detection rate of every month, we can find out the PUD patients in the months of seasons changing, such as February, March, April, August and September are more than those in the other months.3. There are 90 gastric ulcer cases (53.3%), including 3 cardiac ulcer cases (1.8%),36 gastricum ulcer cases (14.2%),12 gastric angle ulcer cases (7.1%),38 gastric antrum ulcer cases (22.5%),5 pyloric canal ulcer cases (3.0%),8 multiple gastric ulcer cases (4.7%). There are 68 doudenal ulcer cases (40.2%). There are 108 small ulcer cases (63.9%),56 big ulcer cases (33.1%) and 5 huge ulcer cases (3.0%). There are 48 Helicobacter pylori (Hp) infected cases (28.4%).4. There are 40 patients using NSAIDs (23.7%),55 patients using anticoagulant drugs (32.5%),7 patients using glucocorticoid (4.1%),3 patients using SSRIs (1.8%). There are 46 patients taking<5 types of drugs (27.3%),92 patients taking≥5 and<10 types of drugs (54.4%), 31 patients taking≥10 types of drugs (18.3%).5. There are 70 smoking patients (41.4%) and 99 non-smoking patients (54.4%). The smoking patients are classified by Smoking Index (SI). There are 2 patients’SI<200(1.2%),20 patients’SI≥200 and<400(11.8%), 48 patients’SI≥400(28.4%).6. The 169 patients all use Proton pump inhibitors (PPIs) to cure peptic ulcer. After regular therapy and Hp eradication therapy, there are 124 patients used maintenance therapy (73.4%). All of the 48 Hp infected patients received regular triple or quadruple Hp eradication therapy. After the therapy,44 infected patients’ Hp were eradicated (91.7%). However there are 4 patients still infected by Hp after a few remedy courses of eradication therapy.7. There are 56 patients (33.1%) receive endoscopy examination after therapy. The follow-up time is from 42 to 1192 days. The follow-up time tends to follow a skew distribution. The median follow-up time is 186 days. The average follow-up time is 276.1 days. 8. As a result, we find 28 recurred peptic ulcer cases (recurrence rate is 16.6%). There are 13 gastric ulcer cases (recurrence rate is 14.4%), including 1 cardiac ulcer cases (recurrence rate is 33.3%),4 gastricum ulcer cases (recurrence rate is 16.7%),2 gastric antrum ulcer cases (recurrence rate is 5.2%),3 gastric angle ulcer cases (recurrence rate is 25.0%),1 pyloric canal ulcer case (recurrence rate is 20.0%),2 multiple gastric ulcer cases (recurrence rate is 25.0%). There are 11 doudenal ulcer cases (recurrence rate is 16.2%) and 4 compound ulcer cases (recurrence rate is 36.4%). There are 9 recurred small ulcer cases (recurrence rate is 8.3%),16 recurred big ulcer cases (recurrence rate is 28.6%) and 3 recurred huge ulcer cases (recurrence rate is 60.0%). There are 6 Helicobacter pylori (Hp) infected cases (21.4%), including 4 failed Hp eradication therapy cases and 2 Hp return positive after eradication therapy cases. The reinfection rate is 4.5%.9. We analyse the potential factors associated with the recurrence of peptic ulcer by using of Logistic stepwise regression model. Smoking (OR=1.788, P=0.001), combined medication of gastric mucosa injury durgs (OR=6.202, P=0.015), ulcer size(OR=2.697, P=0.032) and successful Hp eradication therapy (OR=43.784, P=0.007) are found to be the factors that will influence the recurrence of the elders’peptic ulcer among other potential factors such as age, sex, ulcer regions, Hp infection, use of NSAIDs, use of anticoagulant drugs, quantity of drugs, maintenance therapy.Conclusion1. The successful Hp eradication therapy will heavily influence the recurrence of peptic ulcer disease in old people. The patients that received Hp eradication therapy are necessary to take examinations of Hp on schedule. If the Hp reinfected, it must be eradicated again.2. The combined medication of NSAIDs, anticoagulant durgs and glucocorticoid in old people will remarkably increase the risk of peptic ulcer recurrence. It is necessary to use maintenance therapy and make frequently follow-up for these combined medication patients.3. Smoking is a factor that influence the elders’peptic ulcer recurrence. It is necessary to recommand peptic ulcer patients give up smoking, so that the risk of morbidity and recurrence can be reduced.4. Ulcer size is another factor that influence the elders’peptic ulcer recurrence. The factor must be considered in order to help physicians design appropriate treatment and follow-up strategies.