We thank Lai and Liao for their comments on our study.[1, 2] Whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for peptic ulcer bleeding (PUB) is interesting. Recently, a prospective randomised clinical trial showed that COPD is an independent risk factor for ulcer rebleeding. The fact that data for smoking were unavailable is a weak point in this nationwide population-based cohort study. Therefore, more prospective studies are warranted to clarify the role of smoking in COPD patients with PUB, which we have brought up in the limitations of this study.
We collected data concerning intravenous and oral corticosteroids, but not inhaled preparations. This may be one of the reasons why a lower prescription rate of corticosteroids was noted in our COPD patients. The association between use of corticosteroids and gastric mucosal injury remains controversial. Two previous prospective clinical studies showed that oral prednisolone (60 mg/day) for 3-months and intravenous methylprednisolone (500–1000 mg/day) for 3 days did not increase peptic ulcer risk.[4, 5]
Our other population-based cohort studies also supported the findings that corticosteroids alone do not increase the risk of PUB.[6, 7] However, animal studies showed that corticosteroids delayed gastric ulcer healing.