Abstract
Background: Impairment of activities of daily living (ADL) due to hemorrhagic gastroduodenal ulcers (HGU) has rarely been evaluated. The aim is to analyze the risk factors of poor prognosis, including mortality and impairment of ADL, in patients with HGU.Methods: In total, 582 patients diagnosed with HGU were analyzed. Impairment of ADL was defined as admission to care facilities after hospital discharge, or requirement of home modification for rehabilitation at home. The following clinical factors were evaluated: endoscopic features, need for interventional endoscopic procedures, comorbidities, symptoms, and medications. The risk factors of outcomes were examined with multivariate analysis.Results: Advanced age (> 75 years) was a significant predictor of poor prognosis, including impairment of ADL. Additional significant risk factors were renal disease (odds ratio [OR], 3.43; 95% confidence interval [CI], 1.44–8.14) for overall mortality, proton pump inhibitor (PPIs) usage prior to hemorrhage (OR, 5.80; 95% CI, 2.08–16.2), and heart disease (OR, 3.05; 95% CI, 1.11–8.43) for the impairment of ADL. Analysis of elderly (> 75 years) subjects alone also revealed that use of PPIs prior to hemorrhage was a significant predictor for the impairment of ADL (OR, 8.24; 95% CI, 2.36–28.7).Conclusion: In addition to advanced age, the presence of comorbidities was a risk of poor outcomes in patients with HGU. PPI use prior to hemorrhage was a significant risk factor for the impairment of ADL, both in overall HGU patients and in elderly patients alone. These findings suggest that the current strategy for PPI use needs reconsideration.