Related Experiment Videos
Which peptic ulcers bleed? Results of a case-control study. DUSUK Study Group
1Dept. of General and Trauma Surgery, Heinrich-Heine University, Düsseldorf, Germany.
Insights
Patients with lung disease, those taking non-steroidal anti-inflammatory drugs (NSAID) or aspirin, and individuals without prior ulcer treatment face a higher risk of peptic ulcer bleeding.
Area of Science:
- Gastroenterology
- Internal Medicine
- Pharmacology
Background:
- Despite effective treatments for peptic ulcer disease, ulcer bleeding incidence remains high.
- Limited research has explored the relationship between developing ulcer bleeding and uncomplicated ulcer disease risk.
Purpose of the Study:
- To identify risk factors for peptic ulcer bleeding.
- To compare risk factors for bleeding ulcers versus uncomplicated ulcers.
Main Methods:
- Multicenter interdisciplinary case-control study.
- Endoscopic diagnosis with prospective data collection and multivariate analysis.
- Matched pairs of ulcer bleeding cases and uncomplicated ulcer controls.
Main Results:
- Identified four key risk factors for ulcer bleeding: lung disease, non-steroidal anti-inflammatory drug (NSAID) intake, no H2 blocker pretreatment, and acetylsalicylic acid (aspirin) intake.
- NSAID and aspirin intake significantly increased bleeding risk.
- Duration of ulcer pain and prior ulcer treatments were protective factors.
Conclusions:
- Multimorbid patients, especially those on NSAIDs or aspirin, are at increased risk.
- Patients with no prior ulcer history represent a risk group for peptic ulcer bleeding.
Background:
The incidence of ulcer bleeding has not decrease despite effective medical treatment of peptic ulcer disease. Numerous studies have been performed on risk factors for ulcer bleeding, but only a few studies have related the risk of developing ulcer bleeding to the risk of developing uncomplicated ulcer disease.
Methods:
This study was performed as a multicenter interdisciplinary case-control study and was based on diagnosis by endoscopy, prospective data collection, and multivariate analysis. To every study patient with ulcer bleeding (case) one patient with uncomplicated peptic ulcer proven at endoscopy (control) was assigned with regard to sex, ulcer localization, and age (+/-5 years). The controls were randomly taken from three sources: inpatients, outpatients, and patients treated by a private physician.
Results:
Owing to strict inclusion and exclusion criteria, 209 matched pairs were available for evaluation out of 401 patients with peptic ulcer bleeding. In univariate analysis the duration of ulcer pain and the number of previous ulcer treatments proved to be protective factors for ulcer bleeding. The intake of non-steroidal anti-inflammatory drugs (NSAID) as a whole, acetylsalicylic acid (aspirin), and paracetamol gave an increased risk for ulcer bleeding. Multivariate analysis identified four risk factors for peptic ulcer bleeding: lung disease, NSAID intake, no pretreatment with H2 blockers, and acetylsalicylic acid intake.
Conclusions:
The following patient groups represent a risk for peptic ulcer bleeding: multimorbid patients, receiving NSAID and/or aspirin, and patients with no previous ulcer history.