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

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.

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

“…Recent studies have suggested that patients with heart failure or other cardiovascular diseases, the most common indication for low dose aspirin, might be at higher independent risk for gastrointestinal bleeding [32,56]. Although individual studies did not speci®cally report the effect of controlling for cardiovascular diseases, we have calculated the RR with and without adjustment for cardiovascular diseases using our data and found no major difference: RRs were 1.8 and 2.0, respectively.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…It is well established that the risk of association between NSAIDs and peptic disease and its complications, also depends on other risk factors inherent to the patient, including advanced age, presence of co-morbidities, concomitant drugs, smoking and a history of peptic ulcer disease and bleeding (126,205) . The risk of NSAIDs causing ulceration and bleeding also varies with the toxicity, dosage and duration of the medication used (185) .…”

Mechanisms by which endogenous glucocorticoid protects against indomethacin-induced gastric injury in rats

“…We have shown that indomethacin and aspirin at ulcerogenic doses induce a rise in corticosterone, which helps the gastric mucosa to resist the harmful actions of these ulcerogenic agents (7,8,10). The beneficial effect of an acute elevation in glucocorticoids during NSAID action is the opposite of the well-known ulcerogenic action of longlasting glucocorticoid treatment (14,46). However, the findings support the idea that glucocorticoids released during activation of the hypothalamic-pituitary-adrenocortical (HPA) axis caused by various ulcerogenic stimuli act as a gastroprotective hormone (7,8,10) but not as an ulcerogenic hormone as has generally been accepted for some decades.…”