Chronic Obstructive Pulmonary Disease: An Independent Risk Factor for Peptic Ulcer Bleeding

A Nationwide Population-based Study

K.-W. Huang; J.-C. Luo; H.-B. Leu; H.-C. Lin; F.-Y. Lee; W.-L. Chan; S.-J. Lin; J.-W. Chen; F.-Y. Chang

Disclosures

Aliment Pharmacol Ther. 2012;35(7):796-802. 

In This Article

Abstract and Introduction

Abstract

Background Peptic ulcer bleeding remains a major healthcare problem despite decreasing prevalence of peptic ulcer disease. The role of chronic obstructive pulmonary disease (COPD) in the risk of peptic ulcer bleeding has not yet been established.
Aim To determine if COPD patients have a higher risk of peptic ulcer bleeding than the general population and to identify the risk factors of peptic ulcer bleeding in COPD patients.
Methods From Taiwan's National Health Insurance research database, 62 876 patients, including 32 682 COPD and 30 194 age-gender-matched non-COPD controls, were recruited. Cox proportional hazard regression was performed to evaluate independent risk factors for ulcer bleeding in all patients and to identify risk factors in COPD patients.
Results During the 8-year follow-up, COPD patients had a significant higher rate of peptic ulcer bleeding than the control group (P < 0.001, by log-rank test). By Cox proportional hazard regression analysis, COPD [hazard ratio (HR) 1.93, 95% CI 1.73–2.17] was an independent risk factor after adjusting for age, gender, underlying comorbidities and ulcerogenic medication. Age > 65 years, male, comorbidities of hypertension, diabetes, heart failure, history of peptic ulcer disease, and chronic renal disease and use of nonsteroidal anti-inflammatory drugs were risk factors of ulcer bleeding in COPD patients.
Conclusion Patients with chronic obstructive pulmonary disease have a higher risk of peptic ulcer bleeding after adjustments for possible confounding factors like underlying comorbidities and ulcerogenic medication.

Introduction

Although Helicobacter pylori (H. pylori) infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) play important roles in peptic ulcer formation and bleeding,[1] peptic ulcer disease is not uncommon in patients with chronic medical conditions like liver cirrhosis, renal failure and chronic obstructive pulmonary disease (COPD). In literature, patients who smoke or have COPD carry higher risk of developing peptic ulcer disease.[2,3,4] Moreover, COPD patients often have other smoking-related chronic diseases, such as hypertension, coronary artery disease, or heart failure, and use similar medications, including anti-platelet drugs or corticosteroids. These drugs may be ulcerogenic or delay ulcer healing.[5,6,7]

Peptic ulcer bleeding remains a major healthcare problem[8] with substantial economic impact[9,10] despite decreasing peptic ulcer disease prevalence.[11,12] To date, few population-based studies have evaluated whether COPD really increases peptic ulcer bleeding compared to the general population. Risk factors in COPD patients are also not identified. This nationwide population-based study aimed to investigate the association between COPD and peptic ulcer bleeding after adjusting for potential confounding factors such as comorbidity and ulcerogenic medication, and to identity independent risk factors for ulcer bleeding in COPD patients.

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