Risk Factors Associated with Uncomplicated Peptic Ulcer and Changes in Medication Use after Diagnosis

Abstract

BackgroundFew epidemiologic studies have investigated predictors of uncomplicated peptic ulcer disease (PUD) separately from predictors of complicated PUD.ObjectiveTo analyze risk factors associated with uncomplicated PUD and medication use after diagnosis.MethodsPatients diagnosed with uncomplicated PUD (n = 3,914) were identified from The Health Improvement Network database among individuals aged 40–84 years during 1997–2005, with no previous history of PUD. Prescription records for the year after the date of diagnosis were reviewed and a nested case–control analysis was performed to calculate the odds ratios for the association of potential risk factors with PUD.ResultsMedications associated with developing uncomplicated PUD included current use of acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, selective serotonin reuptake inhibitors, antidepressants, antihypertensives or acid suppressants. Uncomplicated PUD was significantly associated with being a current or former smoker and having had a score of at least 3 on the Townsend deprivation index. Approximately 50% of patients who were users of ASA (19% of patients) or chronic users of NSAIDs (7% of patients) at diagnosis did not receive another prescription of the medication in the 60 days after diagnosis, and 30% were not represcribed therapy within a year. Among patients who were current users of ASA or chronic NSAIDs at the time of the PUD diagnosis and received a subsequent prescription for their ASA or NSAID during the following year, the vast majority (80–90%) also received a proton pump inhibitor coprescription.ConclusionsOur results indicate that several risk factors for upper gastrointestinal bleeding are also predictors of uncomplicated PUD, and that some patients do not restart therapy with ASA or NSAIDs after a diagnosis of uncomplicated PUD. Further investigation is needed regarding the consequences for these patients in terms of increased cardiovascular burden due to discontinuation of antiplatelet therapy.

Management ofHelicobacter pyloriinfection—the Maastricht V/Florence Consensus Report

“…Patients with a history of peptic ulcer or peptic ulcer bleeding are at the highest risk of upper GI bleeding if treated with NSAIDs, coxibs or aspirin 46 54. A few clinical trials49 55 56 and one observational study,50 conducted in these high risk patients of Chinese origin, have shown that H. pylori eradication reduces but does not eliminate that risk, and that PPI co-therapy seems still necessary to reduce further the risk of upper GI bleeding.…”

Superiority of NBI endoscopy to PET/CT scan in detecting esophageal cancer among head and neck cancer patients: a retrospective cohort analysis

“…HNC and PUD share some common risk factors, such as smoking and betel nut chewing [50]. Furthermore, the primary care physician visits, specialist referrals, stress, and depression in HNC patients [51] likely predisposed these patients to have the other risk factors for PUD and may partially explain the high prevalence of PUD in our population. Although the risk factors for the development of PUD in HNC patients were not investigated in the present study, we would like to emphasize the high risk for PUD in HNC patients.…”

Helicobacter pylori, úlcera péptica y cáncer gástrico

“…Estudios similares realizados en otras localizaciones han estimado una prevalencia de 4.1% a 6.2% en Europa, de 8.2% en Irán, de 3.6% en EE.UU. y de 17.2% en China (1,(23)(24)(25)(26)(27)(28)(29). También en el estudio de Cedeño et al (1), la úlcera gástrica fue más frecuente que la duodenal, con una relación aproximada de 1:1.2; hallazgo similar al encontrado en otras zonas con alta incidencia de cáncer de estómago donde la localización gástrica de la úlcera péptica también es más frecuente.…”