PMID- 23371011
OWN - NLM
STAT- MEDLINE
DCOM- 20130826
LR  - 20211021
IS  - 1573-2568 (Electronic)
IS  - 0163-2116 (Linking)
VI  - 58
IP  - 6
DP  - 2013 Jun
TI  - Risk of complications after a peptic ulcer diagnosis: effectiveness of proton 
      pump inhibitors.
PG  - 1653-62
LID - 10.1007/s10620-013-2561-9 [doi]
AB  - BACKGROUND: Few studies have evaluated the prevention of upper gastrointestinal 
      complications (UGIC; bleeding or perforation) in patients with uncomplicated 
      peptic ulcer (PU). We assessed the effect of proton pump inhibitors (PPI) in a 
      non-randomized setting. To maximize exchangeability of exposed and unexposed 
      groups we restricted the study to patients with a new diagnosis of PU, i.e., a 
      clear indication. To minimize selection bias we mimicked an intention to treat 
      approach by assessing the effect of PPI prescription after PU diagnosis. METHODS: 
      Within a population of subjects aged 40-84 years from The Health Improvement 
      Network database, 1997-2006, we identified 3,850 patients with incident PU. Among 
      them, we confirmed 74 first UGIC episodes during a mean follow-up of 4 years. 
      Exposure was prescription coverage during the month following PU diagnosis. We 
      performed a nested case-control analysis and compared UGIC cases with 400 
      controls matched for age, sex, year and duration of follow-up. Relative risks 
      (RR) and 95 % confidence intervals (CI) were estimated. RESULTS: The overall 
      incidence of UGIC was 4.6 cases/1,000 person-years; it was highest during the 
      months after PU diagnosis, increased with age, and it was higher in men and 
      subjects with Helicobacter pylori infection, anemia, and alcohol use at PU 
      diagnosis. The RR for UGIC associated with PPI prescriptions during the month 
      after PU diagnosis was 0.56 (95 % CI 0.31-1.0). The RR for NSAIDs with and 
      without a PPI was 1.72 (0.68-4.45) and 3.27 (0.85-12.67), respectively. 
      CONCLUSIONS: Findings suggest that prescription of PPIs after a PU diagnosis is 
      associated with a reduced risk of UGIC.
FAU - Hernandez-Diaz, Sonia
AU  - Hernandez-Diaz S
AD  - Department of Epidemiology, Harvard School of Public Health, 677 Huntington 
      Avenue, Boston, MA 02115, USA. shernan@hsph.harvard.edu
FAU - Martin-Merino, Elisa
AU  - Martin-Merino E
FAU - Garcia Rodriguez, Luis A
AU  - Garcia Rodriguez LA
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
DEP - 20130131
PL  - United States
TA  - Dig Dis Sci
JT  - Digestive diseases and sciences
JID - 7902782
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Case-Control Studies
MH  - Duodenal Ulcer/complications/*drug therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Intention to Treat Analysis
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer Hemorrhage/epidemiology/*prevention & control
MH  - Peptic Ulcer Perforation/epidemiology/*prevention & control
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Risk
MH  - Stomach Ulcer/complications/*drug therapy
MH  - Treatment Outcome
EDAT- 2013/02/02 06:00
MHDA- 2013/08/27 06:00
CRDT- 2013/02/02 06:00
PHST- 2012/10/10 00:00 [received]
PHST- 2013/01/02 00:00 [accepted]
PHST- 2013/02/02 06:00 [entrez]
PHST- 2013/02/02 06:00 [pubmed]
PHST- 2013/08/27 06:00 [medline]
AID - 10.1007/s10620-013-2561-9 [doi]
PST - ppublish
SO  - Dig Dis Sci. 2013 Jun;58(6):1653-62. doi: 10.1007/s10620-013-2561-9. Epub 2013 
      Jan 31.