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Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding
Colin John Crooks1, Joe West, Timothy Richard Card
1Division of Epidemiology and Public Health, The University of Nottingham, Nottingham City Hospital, Nottingham, UK. colin.crooks@nottingham.ac.uk
Gastroenterology
|March 9, 2013
Summary
Nongastrointestinal comorbidity significantly increases the risk of upper gastrointestinal bleeding (GIB). This comorbidity contributes more to GIB cases in the population than other known factors, highlighting its importance in patient assessment.
Area of Science:
- Gastroenterology
- Epidemiology
- Internal Medicine
Background:
- Upper gastrointestinal bleeding (GIB) incidence remains high despite reduced peptic ulcer disease and improved H. pylori and NSAID management.
- Increasing nongastrointestinal comorbidity in patients with GIB suggests other contributing factors.
Purpose of the Study:
- To investigate the association between nongastrointestinal comorbidity and the risk of nonvariceal upper gastrointestinal bleeding (GIB).
Main Methods:
- A matched case-control study utilized linked English primary and secondary care data (1997-2010).
- 16,355 patients with nonvariceal GIB were matched with 81,636 controls.
- Conditional logistic regression modeled GIB risk factors, including comorbidity assessed by the Charlson Index.
Main Results:
- Comorbidity showed a graded association with GIB risk (OR 1.43 for single, 2.26 for multiple/severe).
- Comorbidity accounted for a substantial population attributable fraction (19.8%) of GIB cases.
- This contribution exceeded that of aspirin or NSAID use.
Conclusions:
- Nongastrointestinal comorbidity is an independent and significant risk factor for upper gastrointestinal bleeding (GIB).
- Comorbidity explains a larger proportion of GIB cases than previously recognized factors.
- Findings aid GIB cause assessment and explain persistent high incidence in aging populations.
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