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Gastroenterology Research and Practice
Volume 2012 (2012), Article ID 956434, 6 pages
http://dx.doi.org/10.1155/2012/956434
Research Article

Management of Peptic Ulcer Bleeding in Different Case Volume Workplaces: Results of a Nationwide Inquiry in Hungary

1Division of Gastroenterology, Department of Internal Medicine, Petz Aladár County and Teaching Hospital, Győr 9024, Hungary
2Department of Gastroenterology, School of Medicine, Debrecen University, Debrecen 4032, Hungary
3Department of Internal Medicine, Jósa András County Hospital, Nyíregyháza 4400, Hungary
4Department of Internal Medicine, Municipal Hospital, Siófok 8600, Hungary
5Department of Surgery, Semmelweis University, Budapest 1083, Hungary
6Department of Internal Medicine, Jávorszky Ödön Municipal Hospital, Vác 2600, Hungary
7Department of Internal Medicine, Kenézy Gyula County Hospital, Debrecen 4031, Hungary

Received 6 June 2012; Revised 30 July 2012; Accepted 30 July 2012

Academic Editor: Charles Melbern Wilcox

Copyright © 2012 István Rácz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The aim of this study was to conduct a national survey to evaluate the recent endoscopic treatment and drug therapy of peptic ulcer bleeding (PUB) patients and to compare practices in high and low case volume Hungarian workplaces. A total of 62 gastroenterology units participated in the six-month study. A total of 3033 PUB cases and a mean of 8 . 1 5 ± 3 . 9 PUB cases per month per unit were reported. In the 23 high case volume units (HCV), there was a mean of 1 2 . 9 ± 5 . 4 PUB cases/month, whereas in the 39 low case volume units (LCV), a mean of 5 . 3 ± 2 . 9 PUB cases/month were treated during the study period. In HCV units, endoscopic therapies for Forrest Ia, Ib, and IIa ulcers were significantly more often used than in LCV units (86% versus 68%; 𝑃 = 0 . 0 0 1 ). Among patients with stigmata of recent haemorrhage (Forrest I, II), bolus + continuous infusion PPI was given significantly more frequently in HCV than in LCV units (49.6% versus 33.2%; 𝑃 = 0 . 0 0 1 ). Mortality in HCV units was less than in LCV units (2.7% versus 4.3%; 𝑃 = 0 . 0 2 3 ). The penetration of evidence-based recommendations for PUB management is stronger in HCV units resulting lower mortality.