Peptic ulcer disease and the nonsteroidal anti-inflammatory drugs

The medical records of 265 patients with peptic ulcer disease were reviewed for a history of nonsteroidal anti-inflammatory drug (NSAID) use preceding hospital admission. Ninety-five patients (36%) gave a history of regular use of such agents. The admission characteristics of the peptic ulcer patient group not using NSAIDs (age, sex, ulcer location, admission indication, method of diagnosis) were virtually identical to those of the group taking NSAIDs. Although 24.5 per cent of patients not taking NSAIDs were admitted because of hemorrhage from their ulcer compared with 28.4 per cent of NSAID users, only 7.5 per cent of nonusers required surgery for hemorrhage control compared to 29.6 per cent of users. Eighty per cent of patients regularly using more than one NSAID required surgery for an ulcer complication. Hemorrhage mortality was 5 per cent among nonusers compared with 14.8 per cent among users. It is concluded that NSAID use by patients with peptic ulcers adversely affects therapeutic response in general and significantly impairs normal hemostatic mechanisms in patients bleeding from an ulcer.