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. 2000 Jan;46(1):27–31. doi: 10.1136/gut.46.1.27

Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs

J Weil 1, M Langman 1, P Wainwright 1, D Lawson 1, M Rawlins 1, R Logan 1, T Brown 1, M Vessey 1, M Murphy 1, D Colin-Jones 1
PMCID: PMC1727776  PMID: 10601050

Abstract

AIMS—To determine risk factors for peptic ulcer bleeding other than non-steroidal anti-inflammatory drugs (NSAIDs).
 Methods—Data on possible antecedent risk factors obtained in a large case control study of 1121 patients admitted to hospitals in Glasgow, Newcastle, Nottingham, Oxford, and Portsmouth with bleeding peptic ulcers were compared with the same information obtained in 989 population controls. Data were analysed by logistic regression with the calculation of odds ratios (OR) and 95% confidence intervals (CI).
RESULTS—From a logistic regression model, oral anticoagulants (OR 7.8; 95% CI 2.8-21.5), previous peptic ulcer (3.8; 2.6-4.9), treatment for heart failure (5.9; 2.3-13.1), oral corticosteroid use (2.7; 1.3-4.5), treatment for diabetes (3.1; 1.2-4.3), and current smoking (1.6; 1.2-2.0) were all independent risk factors. No association was found with use of calcium channel antagonists. Odds ratios for concomitant NSAID usage were multiplicative with the exception of current smoking.
CONCLUSIONS—Some 45% of admissions for peptic ulcer bleeding in England and Wales in those aged 60 or more are calculated to be attributable to, or associated with, these accessory risk factors, which, together with those associated with aspirin or other NSAID use will account for over 80% of predisposing factors to ulcer bleeding.


Keywords: peptic ulcer; risk factors; anti-inflammatory drugs

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Selected References

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  1. Chan F. K., Sung J. J., Chung S. C., To K. F., Yung M. Y., Leung V. K., Lee Y. T., Chan C. S., Li E. K., Woo J. Randomised trial of eradication of Helicobacter pylori before non-steroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet. 1997 Oct 4;350(9083):975–979. doi: 10.1016/s0140-6736(97)04523-6. [DOI] [PubMed] [Google Scholar]
  2. Conn H. O., Blitzer B. L. Nonassociation of adrenocorticosteroid therapy and peptic ulcer. N Engl J Med. 1976 Feb 26;294(9):473–479. doi: 10.1056/NEJM197602262940905. [DOI] [PubMed] [Google Scholar]
  3. Cullen D. J., Hawkey G. M., Greenwood D. C., Humphreys H., Shepherd V., Logan R. F., Hawkey C. J. Peptic ulcer bleeding in the elderly: relative roles of Helicobacter pylori and non-steroidal anti-inflammatory drugs. Gut. 1997 Oct;41(4):459–462. doi: 10.1136/gut.41.4.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. García Rodríguez L. A., Jick H. Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994 Mar 26;343(8900):769–772. doi: 10.1016/s0140-6736(94)91843-0. [DOI] [PubMed] [Google Scholar]
  5. García Rodríguez L. A., Walker A. M., Pérez Gutthann S. Nonsteroidal antiinflammatory drugs and gastrointestinal hospitalizations in Saskatchewan: a cohort study. Epidemiology. 1992 Jul;3(4):337–342. doi: 10.1097/00001648-199207000-00008. [DOI] [PubMed] [Google Scholar]
  6. Griffin M. R., Piper J. M., Daugherty J. R., Snowden M., Ray W. A. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991 Feb 15;114(4):257–263. doi: 10.7326/0003-4819-114-4-257. [DOI] [PubMed] [Google Scholar]
  7. Hawkey C. J., Tulassay Z., Szczepanski L., van Rensburg C. J., Filipowicz-Sosnowska A., Lanas A., Wason C. M., Peacock R. A., Gillon K. R. Randomised controlled trial of Helicobacter pylori eradication in patients on non-steroidal anti-inflammatory drugs: HELP NSAIDs study. Helicobacter Eradication for Lesion Prevention. Lancet. 1998 Sep 26;352(9133):1016–1021. doi: 10.1016/s0140-6736(98)04206-8. [DOI] [PubMed] [Google Scholar]
  8. Hochain P., Berkelmans I., Czernichow P., Duhamel C., Tranvouez J. L., Lerebours E., Colin R. Which patients taking non-aspirin non-steroidal anti-inflammatory drugs bleed? A case-control study. Eur J Gastroenterol Hepatol. 1995 May;7(5):419–426. [PubMed] [Google Scholar]
  9. Kaufman D. W., Kelly J. P., Sheehan J. E., Laszlo A., Wiholm B. E., Alfredsson L., Koff R. S., Shapiro S. Nonsteroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding. Clin Pharmacol Ther. 1993 Apr;53(4):485–494. doi: 10.1038/clpt.1993.55. [DOI] [PubMed] [Google Scholar]
  10. Kelly J. P., Laszlo A., Kaufman D. W., Sundstrom A., Shapiro S. Major upper gastrointestinal bleeding and the use of calcium channel blockers. Lancet. 1999 Feb 13;353(9152):559–559. doi: 10.1016/S0140-6736(98)05202-7. [DOI] [PubMed] [Google Scholar]
  11. Langman M. J., Weil J., Wainwright P., Lawson D. H., Rawlins M. D., Logan R. F., Murphy M., Vessey M. P., Colin-Jones D. G. Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994 Apr 30;343(8905):1075–1078. doi: 10.1016/s0140-6736(94)90185-6. [DOI] [PubMed] [Google Scholar]
  12. Laporte J. R., Carné X., Vidal X., Moreno V., Juan J. Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Catalan Countries Study on Upper Gastrointestinal Bleeding. Lancet. 1991 Jan 12;337(8733):85–89. doi: 10.1016/0140-6736(91)90744-a. [DOI] [PubMed] [Google Scholar]
  13. Meade T. W., Roderick P. J., Brennan P. J., Wilkes H. C., Kelleher C. C. Extra-cranial bleeding and other symptoms due to low dose aspirin and low intensity oral anticoagulation. Thromb Haemost. 1992 Jul 6;68(1):1–6. [PubMed] [Google Scholar]
  14. Messer J., Reitman D., Sacks H. S., Smith H., Jr, Chalmers T. C. Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983 Jul 7;309(1):21–24. doi: 10.1056/NEJM198307073090105. [DOI] [PubMed] [Google Scholar]
  15. Pahor M., Guralnik J. M., Furberg C. D., Carbonin P., Havlik R. Risk of gastrointestinal haemorrhage with calcium antagonists in hypertensive persons over 67 years old. Lancet. 1996 Apr 20;347(9008):1061–1065. doi: 10.1016/s0140-6736(96)90276-7. [DOI] [PubMed] [Google Scholar]
  16. Piper J. M., Ray W. A., Daugherty J. R., Griffin M. R. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Intern Med. 1991 May 1;114(9):735–740. doi: 10.7326/0003-4819-114-9-735. [DOI] [PubMed] [Google Scholar]
  17. Savage R. L., Moller P. W., Ballantyne C. L., Wells J. E. Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy. Arthritis Rheum. 1993 Jan;36(1):84–90. doi: 10.1002/art.1780360114. [DOI] [PubMed] [Google Scholar]
  18. Silverstein F. E., Graham D. Y., Senior J. R., Davies H. W., Struthers B. J., Bittman R. M., Geis G. S. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995 Aug 15;123(4):241–249. doi: 10.7326/0003-4819-123-4-199508150-00001. [DOI] [PubMed] [Google Scholar]
  19. Smalley W. E., Ray W. A., Daugherty J. R., Griffin M. R. No association between calcium channel blocker use and confirmed bleeding peptic ulcer disease. Am J Epidemiol. 1998 Aug 15;148(4):350–354. doi: 10.1093/oxfordjournals.aje.a009652. [DOI] [PubMed] [Google Scholar]
  20. Weil J., Colin-Jones D., Langman M., Lawson D., Logan R., Murphy M., Rawlins M., Vessey M., Wainwright P. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ. 1995 Apr 1;310(6983):827–830. doi: 10.1136/bmj.310.6983.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Younossi Z. M., Strum W. B., Schatz R. A., Teirstein P. S., Cloutier D. A., Spinks T. J. Effect of combined anticoagulation and low-dose aspirin treatment on upper gastrointestinal bleeding. Dig Dis Sci. 1997 Jan;42(1):79–82. doi: 10.1023/a:1018833021039. [DOI] [PubMed] [Google Scholar]

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