Acute upper gastrointestinal bleeding: comparison between recent users and nonusers of nonsteroidal anti-inflammatory drugs.

摘要

BACKGROUND AND STUDY AIMS: To determine clinical, endoscopic, and outcome differences between recent users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs) presenting with upper gastrointestinal bleeding (UGIB). PATIENTS AND METHODS: A total of 330 consecutive patients who presented with clinical manifestations of UGIB underwent urgent endoscopy after clinical assessment within 12 h of admission. The patients were divided into two groups, depending on whether there was a positive or negative history of recent NSAID use. Urgent endoscopy followed by endoscopic hemostasis and/or biopsy, as needed, was performed by the same endoscopist, who was blinded to the patients' clinical status. RESULTS: The baseline characteristics, clinically estimated severity of UGIB, and outcome did not differ between the two groups. Recent NSAID users were found to bleed from an ulcer more frequently ( P = 0.009) than nonusers of NSAIDs, the latter more often having a history of peptic ulcer or UGIB ( P = 0.02). Bleeding ulcers were mostly duodenal in the NSAID group and gastric in the non-NSAID group ( P < 0.001). Helicobacter pylori infection was significantly more common among NSAID users ( P < 0.01). The group of NSAID users included a significantly greater proportion of alcohol abusers ( P = 0.01), who were found to bleed mostly from erosive gastritis. CONCLUSIONS: Recent NSAID users were found to bleed from ulcers, mostly duodenal, and to have H. pylori infection more frequently than UGI bleeders with a negative history of NSAID consumption. Alcohol abuse was also more common among NSAID users. The severity of bleeding and the outcome did not differ between the two groups.