Risk of Peptic Ulcer Bleeding Associated with Helicobacter pylori Infection, Nonsteroidal Anti-inflammatory Drugs, and Low-dose Aspirin Therapy in Peptic Ulcer Disease: A Case-control Study
10.7704/kjhugr.2019.19.1.42
- Author:
Seung In SEO
1
;
Jin Gu KANG
;
Hyoung Su KIM
;
Woon Geon SHIN
;
Myoung Kuk JANG
;
Jin Heon LEE
;
Hak Yang KIM
Author Information
1. Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. bacter@hallym.or.kr
- Publication Type:Original Article
- Keywords:
Aspirin;
Helicobacter pylori;
Nonsteroidal anti-inflammatory agents;
Peptic ulcer
- MeSH:
Anti-Inflammatory Agents, Non-Steroidal;
Aspirin;
Case-Control Studies;
Helicobacter pylori;
Helicobacter;
Hemorrhage;
Humans;
Logistic Models;
Multivariate Analysis;
Odds Ratio;
Peptic Ulcer;
Proton Pumps;
Risk Factors;
Smoke;
Smoking;
Stomach Ulcer;
Ulcer;
Warfarin
- From:The Korean Journal of Helicobacter and Upper Gastrointestinal Research
2019;19(1):42-47
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: The association between Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin therapy as a risk factor for peptic ulcer bleeding (PUB) remains unclear. This study investigated the risk of PUB associated with H. pylori infection and NSAID or low-dose aspirin therapy in patients with PUD. MATERIALS AND METHODS: This case-control study investigated 340 patients with PUB between 2012 and 2016. The control group comprised age and sex-matched patients with endoscopically documented non-bleeding ulcers. Using logistic regression analysis, the adjusted odds ratio (AOR) was calculated for the risk of PUB. RESULTS: Of the patients investigated, 57.9% in the study group and 51.8% in the control group were diagnosed with H. pylori infection (P=0.106). Logistic regression analysis showed synergistic interaction between H. pylori infection and low-dose aspirin therapy. Multivariate analysis showed that low-dose aspirin (AOR 3.92, P < 0.001), NSAIDs (AOR 2.98, P=0.001), warfarin (AOR 14.57, P=0.011), gastric ulcer (compared with duodenal ulcer) (AOR 1.65, P=0.01), and smoking (AOR 1.97, P=0.004) increased the risk of PUB compared with the risk of PUD. CONCLUSIONS: Both NSAIDs and aspirin are independent risk factors for bleeding in patients with PUD. Additionally, low-dose aspirin therapy concomitant with H. pylori infection produced a synergistic effect. Therefore, H. pylori eradication may be crucial in aspirin users. Moreover, a proton pump inhibitor should be prescribed in patients with a history of bleeding ulcers who need long-term NSAID treatment.
