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Risk of peptic ulcer bleeding associated with Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, low-dose aspirin, and antihypertensive drugs: a case-control study.
J Gastroenterol Hepatol. 2015 Feb; 30(2):292-8.JG

Abstract

BACKGROUND AND AIM

The associations between antithrombotic or antihypertensive drugs and peptic ulcer bleeding (PUB) remain unknown, particularly in Asia, where Helicobacter pylori infection is prevalent. This study aims to evaluate the risks of PUB from antithrombotic drugs, angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, α-blockers, and β-blockers.

METHODS

This prospective hospital-based case-control study included 230 patients with endoscopically verified PUB and 920 age and sex-matched controls (1:4) without bleeding on screening endoscopy. Adjusted odds ratios (AOR) for the risk of PUB were determined by conditional logistic regression analysis.

RESULTS

In multivariate analysis, alcohol consumption (AOR, 2.2; P < 0.001), history of peptic ulcer (AOR, 4.8; P < 0.001), H. pylori infection (AOR, 2.1; P < 0.001), comorbidity index (AOR, 1.1; P = 0.089), nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR, 2.0; P = 0.025), and low-dose aspirin (AOR, 2.8; P = 0.003) increased the risk of PUB, whereas H. pylori eradication (AOR, 0.03; P < 0.001), proton pump inhibitors (PPIs) (AOR, 0.1; P < 0.001), and histamine 2-receptor antagonists (H2RA) (AOR, 0.1; P < 0.001) reduced it. No significant interactions were observed between H. pylori infection and NSAIDs use for PUB (P = 0.913). ARBs (P = 0.564), ACE inhibitors (P = 0.213), calcium channel blockers (P = 0.215), α-blockers (P = 0.810), and β-blockers (P = 0.864) were not associated with PUB.

CONCLUSION

We found that alcohol consumption, history of peptic ulcer, H. pylori infection, NSAIDs use, and low-dose aspirin use were independent risk factors for PUB, whereas H. pylori-eradication, PPIs use, and H2RA use reduced its risk. Interactions between H. pylori and NSAIDs use in PUB were not observed. No antihypertensive drug was associated with PUB.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25339607

Citation

Nagata, Naoyoshi, et al. "Risk of Peptic Ulcer Bleeding Associated With Helicobacter Pylori Infection, Nonsteroidal Anti-inflammatory Drugs, Low-dose Aspirin, and Antihypertensive Drugs: a Case-control Study." Journal of Gastroenterology and Hepatology, vol. 30, no. 2, 2015, pp. 292-8.
Nagata N, Niikura R, Sekine K, et al. Risk of peptic ulcer bleeding associated with Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, low-dose aspirin, and antihypertensive drugs: a case-control study. J Gastroenterol Hepatol. 2015;30(2):292-8.
Nagata, N., Niikura, R., Sekine, K., Sakurai, T., Shimbo, T., Kishida, Y., Tanaka, S., Aoki, T., Okubo, H., Watanabe, K., Yokoi, C., Akiyama, J., Yanase, M., Mizokami, M., & Uemura, N. (2015). Risk of peptic ulcer bleeding associated with Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, low-dose aspirin, and antihypertensive drugs: a case-control study. Journal of Gastroenterology and Hepatology, 30(2), 292-8. https://doi.org/10.1111/jgh.12805
Nagata N, et al. Risk of Peptic Ulcer Bleeding Associated With Helicobacter Pylori Infection, Nonsteroidal Anti-inflammatory Drugs, Low-dose Aspirin, and Antihypertensive Drugs: a Case-control Study. J Gastroenterol Hepatol. 2015;30(2):292-8. PubMed PMID: 25339607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of peptic ulcer bleeding associated with Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, low-dose aspirin, and antihypertensive drugs: a case-control study. AU - Nagata,Naoyoshi, AU - Niikura,Ryota, AU - Sekine,Katsunori, AU - Sakurai,Toshiyuki, AU - Shimbo,Takuro, AU - Kishida,Yoshihiro, AU - Tanaka,Shohei, AU - Aoki,Tomonori, AU - Okubo,Hidetaka, AU - Watanabe,Kazuhiro, AU - Yokoi,Chizu, AU - Akiyama,Junichi, AU - Yanase,Mikio, AU - Mizokami,Masashi, AU - Uemura,Naomi, PY - 2014/09/26/accepted PY - 2014/10/24/entrez PY - 2014/10/24/pubmed PY - 2016/3/22/medline KW - acetylsalicylic acid KW - bleeding ulcer KW - helicobacter pylori KW - interaction KW - non-variceal upper gastrointestinal bleeding SP - 292 EP - 8 JF - Journal of gastroenterology and hepatology JO - J Gastroenterol Hepatol VL - 30 IS - 2 N2 - BACKGROUND AND AIM: The associations between antithrombotic or antihypertensive drugs and peptic ulcer bleeding (PUB) remain unknown, particularly in Asia, where Helicobacter pylori infection is prevalent. This study aims to evaluate the risks of PUB from antithrombotic drugs, angiotensin II receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, α-blockers, and β-blockers. METHODS: This prospective hospital-based case-control study included 230 patients with endoscopically verified PUB and 920 age and sex-matched controls (1:4) without bleeding on screening endoscopy. Adjusted odds ratios (AOR) for the risk of PUB were determined by conditional logistic regression analysis. RESULTS: In multivariate analysis, alcohol consumption (AOR, 2.2; P < 0.001), history of peptic ulcer (AOR, 4.8; P < 0.001), H. pylori infection (AOR, 2.1; P < 0.001), comorbidity index (AOR, 1.1; P = 0.089), nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR, 2.0; P = 0.025), and low-dose aspirin (AOR, 2.8; P = 0.003) increased the risk of PUB, whereas H. pylori eradication (AOR, 0.03; P < 0.001), proton pump inhibitors (PPIs) (AOR, 0.1; P < 0.001), and histamine 2-receptor antagonists (H2RA) (AOR, 0.1; P < 0.001) reduced it. No significant interactions were observed between H. pylori infection and NSAIDs use for PUB (P = 0.913). ARBs (P = 0.564), ACE inhibitors (P = 0.213), calcium channel blockers (P = 0.215), α-blockers (P = 0.810), and β-blockers (P = 0.864) were not associated with PUB. CONCLUSION: We found that alcohol consumption, history of peptic ulcer, H. pylori infection, NSAIDs use, and low-dose aspirin use were independent risk factors for PUB, whereas H. pylori-eradication, PPIs use, and H2RA use reduced its risk. Interactions between H. pylori and NSAIDs use in PUB were not observed. No antihypertensive drug was associated with PUB. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/25339607/Risk_of_peptic_ulcer_bleeding_associated_with_Helicobacter_pylori_infection_nonsteroidal_anti_inflammatory_drugs_low_dose_aspirin_and_antihypertensive_drugs:_a_case_control_study_ L2 - https://doi.org/10.1111/jgh.12805 DB - PRIME DP - Unbound Medicine ER -