Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs

Aims-To determine risk factors for peptic ulcer bleeding other than non-ste roidal anti-inflammatory drugs (NSAIDs). Methods-Data on possible antecedent risk factors obtained in a large case c ontrol study of 1121 patients admitted to hospitals in Glasgow, Newcastle, Nottingham, Oxford, and Portsmouth with bleeding peptic ulcers were compare d with the same information obtained in 989 population controls. Data mere analysed by logistic regression with the calculation of odds ratios (OR) an d 95% confidence intervals (CI). Results-From a logistic regression model, oral anticoagulants (OR 7.8; 95% CI 2.8-21.5), previous peptic ulcer (3.8; 2.6-4.9), treatment for heart fai lure (5.9; 2.3-13.1), oral corticosteroid use (2.7; 1.3-4.5), treatment for diabetes (3.1; 1.2-1.3), and current smoking (1.6; 1.2-2.0) were all indep endent risk factors. No association was found with use of calcium channel a ntagonists. Odds ratios for concomitant NSAID usage were multiplicative wit h the exception of current smoking. Conclusions-Some 45% of admissions for peptic ulcer bleeding in England and Wales in those aged 60 or more are calculated to be attributable to, or as sociated with, these accessory risk factors, which, together with those ass ociated with aspirin or other NSAID use will account for over 80% of predis posing factors to ulcer bleeding.