Supplementary Material for: Systematic Review of the Epidemiology of Complicated Peptic Ulcer Disease: Incidence, Recurrence, Risk Factors and Mortality

Background/Aims: The incidence of uncomplicated peptic ulcer has decreased in recent years. It is unclear what the impact of this has been on the epidemiology of peptic ulcer complications. This systematic review aimed to determine the incidence, recurrence and mortality of complicated peptic ulcer and the risk factors associated with these events. Methods: Systematic PubMed searches. Results: Overall, 93 studies were identified. Annual incidence estimates of peptic ulcer hemorrhage and perforation were 19.4–57.0 and 3.8–14 per 100,000 individuals, respectively. The average 7-day recurrence of hemorrhage was 13.9% (95% CI: 8.4–19.4), and the average long-term recurrence of perforation was 12.2% (95% CI: 2.5–21.9). Risk factors for peptic ulcer complications and their recurrence included nonsteroidal anti-inflammatory drug and/or acetylsalicylic acid use, Helicobacter pylori infection and ulcer size ≧1 cm. Proton pump inhibitor use reduced the risk of peptic ulcer hemorrhage. Average 30-day mortality was 8.6% (95% CI: 5.8–11.4) after hemorrhage and 23.5% (95% CI: 15.5–31.0) after perforation. Older age, comorbidity, shock and delayed treatment were associated with increased mortality. Conclusions: Complicated peptic ulcer remains a substantial healthcare problem which places patients at a high risk of recurrent complications and death.

背景/目的：近年来，非复杂性消化性溃疡的发病率呈下降趋势。目前尚不明确这一变化对消化性溃疡并发症的流行病学特征产生了何种影响。本系统综述旨在明确复杂性消化性溃疡的发病率、复发率与死亡率，以及与这些转归相关的危险因素。
方法：系统检索PubMed数据库。
结果：共纳入93项研究。消化性溃疡出血与穿孔的年发病率估算值分别为每10万人19.4~57.0例和3.8~14例。出血患者的平均7天复发率为13.9%（95% CI：8.4~19.4），穿孔患者的平均长期复发率为12.2%（95% CI：2.5~21.9）。消化性溃疡并发症及其复发的危险因素包括非甾体类抗炎药（nonsteroidal anti-inflammatory drug，NSAIDs）和/或乙酰水杨酸（acetylsalicylic acid，即阿司匹林）使用、幽门螺杆菌（Helicobacter pylori）感染以及溃疡直径≥1 cm。质子泵抑制剂（proton pump inhibitor，PPI）的使用可降低消化性溃疡出血的发生风险。出血患者的平均30天死亡率为8.6%（95% CI：5.8~11.4），穿孔患者则为23.5%（95% CI：15.5~31.0）。高龄、合并症、休克及治疗延迟与死亡率升高相关。
结论：复杂性消化性溃疡仍是一项严峻的医疗卫生保健问题，会使患者面临复发并发症与死亡的高风险。