*DISEASE* GI bleeds and GI ulcers

[CarolineMorton]

LSHTM to find Gi bleeds codes @hmcd + Ian Douglas + Anna Schultze + Angel

[CarolineMorton]

Code List V2 from LSHTM from Ian Douglas

GI_Bleed_Ulcer.xlsx

[hjforbes]

@ianjdouglas I'm working on this code list now. Are we only interested in actual evidence of a GI bleed and NOT ulcer? If so I will remove the ulcer codes if they do not indicate a bleed.

[hjforbes]

DEFINITION: A history of, or currently active, GI bleed or GI ulcer.

Ian has explained we need to exclude people with a history of GI bleed or previous GI ulcer as they’re contraindications for NSAID use.

The main ulcers will be peptic ulcers, but included are all ulcers affecting any part of the GI tract, in line with NICE guidance on NSAID contraindications: https://cks.nice.org.uk/nsaids-prescribing-issues#!scenario.

STEP 1: Read codes version 2 I have updated Ian’s code list using the latest CPRD code browser (July 2019). There were an additional 26 codes, which are flagged with a 1 in the additional column. @CarolineMorton can you check these? The only major difference with Ian’s list is I have included anal and rectal ulcer codes.

gi_bleed_ulcer_version2.xlsx

STEP 2: QOF - none

[CarolineMorton]

HI @hjforbes

gi_bleed_ulcer_version2-CM.xlsx

See excel doc. I have added a column and put a Y for those that should be included, and a N for those that should not. Roughly speaking I have removed the lower GI or rectal ulcers, which most likely represent malignancy or infection and are not relevant for upper GI bleed or ulcer.

I have also excluded neonatal ulcer as this feels also not relevant for our population.

Thanks

[hjforbes]

Thanks Caroline.

STEP 1: GI bleed or GI ulcer Read version 2 code list gi_bleed_ulcer_version3.xlsx

STEP 2: QOF - none

STEP 3: SNOMED cluster snomed-gi_bleed_ulcer.xlsx

Final comment, can we change the code list title to GI bleeds and GI ulcers, to reflect this code list?

[CarolineMorton]

no problem. i will do that now. thanks @hjforbes

[hjforbes]

I have reviewed the TPP list and applied the same inclusion/exclusion criteria we made to the Read version 2 code list. Codes to keep are flagged 1 in the Include column. @CarolineMorton do you want to glance over it and check? GIBleedAndUlcer_CTV3_Raw_HF_checked.xlsx

Small addition to the definition of this variable below in bold (@ianjdouglas can you check this): DEFINITION: A history of, or currently active, GI bleed or GI ulcer. We have not included non-specific symptoms of GI bleed or ulcer, such as haematemesis (blood in vomit) or melaena (blood in stools).

Here is a copy of the do file with the steps taken to create this code list, if helpful. [Uploading GI_bleed_or_ulcer_do_file_code.txt…]()

[ianjdouglas]

Thanks very much Harriet, yes that makes sense

[CarolineMorton]

FINAL SIGN OFF Summary of comments above

DEFINITION: A history of, or currently active, GI bleed or GI ulcer.

NOTES: We have not included non-specific symptoms of GI bleed or ulcer, such as haematemesis (blood in vomit) or melaena (blood in stools). Ian (@ianjdouglas) has explained we need to exclude people with a history of GI bleed or previous GI ulcer as they’re contraindications for NSAID use. The main ulcers will be peptic ulcers, but included are all ulcers affecting any part of the GI tract, in line with NICE guidance on NSAID contraindications: https://cks.nice.org.uk/nsaids-prescribing-issues#!scenario.

CODE LISTS: Final code list here (in CtV3 or read code 3) - GIBleedAndUlcerfinal.xlsx. This was compiled by the following steps.

STEP 1: GI bleed or GI ulcer Read version 2 code list gi_bleed_ulcer_version3.xlsx. @hjforbes updated Ian’s code list using the latest CPRD code browser (July 2019). There were an additional 26 codes, which are flagged with a 1 in the additional column. @CarolineMorton checked these (see above -https://github.com/ebmdatalab/tpp-sql-notebook/issues/51#issuecomment-609088949) and we ended with the linked read 2 code list.

STEP 2: QOF - none

STEP 3: SNOMED cluster: snomed-gi_bleed_ulcer.xlsx

STEP 4 Sense check the final TPP generated list of Read Code 3 codes. Compiled by @hjforbes with minor help from @CarolineMorton for clinical queries. No changes required after review by @CarolineMorton. please note that '0' is for not including, '1' is to include. REVIEWED list added here: GIBleedAndUlcer_CTV3_Raw_HF_checked.xlsx.

• FLEXIBILITY NEEDED BETWEEN STUDIES: None
• EFFECTS ON COHORT SELECTION: Patients must have been registered for at least 12 months before the index date, in order to allow for recording of disease codes.

POTENTIAL BIASES: We have not included symptoms of upper gi bleed such as malaena which may miss some patients; but also avoids adding in other causes or unconfirmed pathology.

CLINICAL SIGN OFF & DATE: Caroline Morton (@CarolineMorton) 7/4/2020 21:17

EPIDEMIOLOGY SIGN OFF & DATE: Ian Douglas (@ianjdouglas) 8/4/2020 16:01

SHARED WITH WIDER TEAM: Yes

FINAL SIGN OFF DATE (and apply label) 8/4/2020 17:05