Long-term risk of recurrent peptic ulcer bleeding in patients with liver cirrhosis: A 10-year nationwide cohort study

Authors

  • Yao-Chun Hsu,

    1. Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
    2. Graduate Institute of Clinical Medicine and College of Public Health, China Medical University, Taichung, Taiwan
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  • Jaw-Town Lin,

    1. Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
    2. Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
    3. Center for Health Policy Research and Development, National Health Research Institutes; Miaoli, Taiwan
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  • Tzu-Ting Chen,

    1. Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
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  • Ming-Shiang Wu,

    1. Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
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  • Chun-Ying Wu

    Corresponding author
    1. Graduate Institute of Clinical Medicine and College of Public Health, China Medical University, Taichung, Taiwan
    2. Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
    3. Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
    4. Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan
    • Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan 155, Sec. 2, Linong Street, Taipei 112, Taiwan
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    • fax: (886)-4-23741331


  • Potential conflict of interest: Nothing to report.

  • Supported in part by the National Health Research Institutes of Taiwan (grants PH-099-PP-26 and PH-099-PP-16) and Taichung Veterans General Hospital, Taiwan (grant TCVGH-1003304C).

Abstract

Peptic ulcer bleeding leads to substantial morbidity and mortality in patients with liver cirrhosis, but their long-term risk of recurrent bleeding remains elusive. This nationwide cohort study aimed to elucidate the association between cirrhosis and recurrent peptic ulcer bleeding by analyzing the Taiwan National Health Insurance Research Database. We enrolled a total of 9,711 patients who had cirrhosis with clinical complications of portal hypertension from all patients (n = 271,030) hospitalized for peptic ulcer bleeding between January 1997 and December 2006, along with 38,844 controls who were matched at a 1:4 proportion for age, sex, and antisecretory agents. We accounted for death as the competing cause of risk when calculating the cumulative incidences and hazard ratios of recurrent bleeding during the 10-year study period. Overall, patients with cirrhosis had a significantly higher death-adjusted rebleeding rate compared with controls (1 year, 14.4% versus 11.3%; 5 years, 26.1% versus 22.5%; 10 years, 28.4% versus 27.1%; P < 0.001). The modified Cox proportional hazard model verified that cirrhosis was significantly associated with peptic ulcer rebleeding (adjusted hazard ratio, 3.19; 95% confidence interval, 2.62-3.88), but also uncovered a seemingly paradoxical interaction between cirrhosis and age. Multivariate stratified analysis further revealed that the rebleeding risk after adjustment for death diminished with age in patients with cirrhosis, whose risk of death far exceeded that of rebleeding when they grew old. Conclusion: Liver cirrhosis is associated with long-term risk of recurrent peptic ulcer bleeding, although the risk declines with age because of death being the competing cause. Effective therapy should be sought to reduce this excessive risk in these critically ill patients, particularly for those at younger age with longer life expectancy. (HEPATOLOGY 2012)

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