Original Article

Cirrhotic patients at increased risk of peptic ulcer bleeding: a nationwide population-based cohort study

  1. J.-C. Luo1,2,*,
  2. H.-B. Leu1,3,4,
  3. M.-C. Hou1,2,
  4. C.-C. Huang1,3,5,
  5. H.-C. Lin1,2,
  6. F.-Y. Lee1,2,
  7. F.-Y. Chang1,2,
  8. W.-L. Chan1,3,4,
  9. S.-J. Lin3,5,6,7,
  10. J.-W. Chen3,5,6,8

Article first published online: 23 JUL 2012

DOI: 10.1111/j.1365-2036.2012.05225.x

Issue

Alimentary Pharmacology & Therapeutics

Alimentary Pharmacology & Therapeutics

Volume 36, Issue 6, pages 542–550, September 2012

Additional Information

How to Cite

Luo, J.-C., Leu, H.-B., Hou, M.-C., Huang, C.-C., Lin, H.-C., Lee, F.-Y., Chang, F.-Y., Chan, W.-L., Lin, S.-J. and Chen, J.-W. (2012), Cirrhotic patients at increased risk of peptic ulcer bleeding: a nationwide population-based cohort study. Alimentary Pharmacology & Therapeutics, 36: 542–550. doi: 10.1111/j.1365-2036.2012.05225.x

Author Information

  1. 1

    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

  2. 2

    Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

  3. 3

    Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

  4. 4

    Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan

  5. 5

    Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

  6. 6

    Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

  7. 7

    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

  8. 8

    Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan

* Correspondence to:
Dr J.-C. Luo, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shih-Pai Road, Section 2, Taipei, 11217 Taiwan.
E-mail: jcluo@vghtpe.gov.tw

Publication History

  1. Issue published online: 23 AUG 2012
  2. Article first published online: 23 JUL 2012
  3. Manuscript Accepted: 2 JUL 2012
  4. Manuscript Revised: 8 JUN 2012
  5. Manuscript Revised: 4 JUN 2012
  6. Manuscript Received: 12 MAY 2012

Funded by

  • Taipei Veterans General Hospital. Grant Numbers: V100C-026, V101C-028

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Summary

Background

Few large population-based studies have compared the occurrence of peptic ulcer bleeding (PUB) in cirrhotic and noncirrhotic patients.

Aims

To investigate if cirrhotic patients have higher risk of PUB than the general population and to identify possible risk factors of PUB in cirrhotic patients.

Methods

Using the National Health Insurance Research Database, a nationwide population-based dataset in Taiwan and matching age, gender, comorbidities and ulcerogenic medication by propensity score, 4013 cirrhotic patients, 8013 chronic hepatitis patients and 7793 normal controls were compared. The log-rank test was used to analyse differences in accumulated PUB-free survival rates between the groups. Cox proportional hazard regressions were performed to evaluate independent risk factors for PUB in all patients and identified risk factors of PUB in cirrhotic patients.

Results

During the 7-year follow-up, cirrhotic patients had significantly higher incidences of PUB than chronic hepatitis patients and controls, respectively (P < 0.001 by log-rank test). By Cox proportional hazard regression analysis, cirrhosis was independently associated with increased risk of PUB (hazard ratio: 4.22; 95% CI 3.37–5.29, P < 0.001) after adjusting for age, gender, economic status, underlying comorbidities and ulcerogenic medication. Age, male, diabetes, chronic renal disease, history of gastro-oesophageal variceal bleeding and use of nonsteroidal anti-inflammatory drugs were risk factors for PUB in cirrhotic patients.

Conclusion

Cirrhotic patients have a significantly higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like age, gender, economic status, underlying comorbidities and ulcerogenic medication.

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