ASSOCIATION OF COCAINE AND METHAMPHETAMINE USE WITH GIANT GASTRODUODENAL ULCERS

Objectives: Giant gastric and duodenal ulcers (>2-3 cm in greatest dim ension) are reported to have higher rates of complication and mortalit y and to be associated with increasing age, renal failure, and use of nonsteroidal antiinflammatory drugs (NSAIDs). This study investigated the outcome and associations of gastric and duodenal ulcers >2.5 cm co mpared to ulcers of lesser size. Methods: Records from all patients wi th gastric and duodenal ulcers >0.5 cm diagnosed by upper endoscopy be tween January 1994 and September 1995 were studied for evidence of con current use of aspirin, NSAIDs, methamphetamine, and cocaine, as well as for transfusion requirements, length of hospital stay, mortality, s urgery, rebleeding, Helicobacter pylori infection, and malignancy. Res ults: A logistic regression analysis of the 220 patients identified re vealed that recent methamphetamine and/or cocaine use was significantl y predictive of giant ulcer formation (p = 0.0002) with an odds ratio of 9.66. Also significant was younger age (p = 0.026) and aspirin or N SAID use (p = 0.046). H. pylori infection was significant only for gia nt gastric ulcers (p = 0.031). Ulcer size did not predict mortality, r ate of rebleeding, requirement for surgery, transfusion requirements, or length of hospital stay. However, giant gastric ulcers were signifi cantly more likely to be malignant (p 0.002). Conclusions: Giant gastr ic and duodenal ulcers were strongly associated with stimulant abuse. They were also associated with younger age and use of aspirin or NSAID s. Additionally, giant gastric ulcers were associated with malignancy and H. pylori infection. Ulcer size did not predict rate of complicati ons or outcome.