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22-02-2012 | Gastroenterology | Article

COPD patients at increased risk for peptic ulcer bleeding


Free abstract

MedWire News: Patients with chronic obstructive pulmonary disease (COPD) are nearly twice as likely to develop peptic ulcer bleeding as the general population, suggest study findings that also identified a number of important risk factors in these patients.

Previous studies comparing the incidence of peptic ulcer bleeding in COPD patients and the general population have failed to adequately match the incidence of comorbid disease in both groups.

To address this shortcoming, Jiing-Chyuan Luo (Taipei Veterans General Hospital, Taiwan) and colleagues performed regression analysis on independent risk factors for ulcer bleeding using data from 32,682 COPD patients and 30,194 age- and gender-matched healthy controls identified from the Taiwan National Health Insurance research database.

Concurrent use of ulcerogenic medication such as acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs), clopidogrel, ticlopidine, and warfarin was not significantly different between the groups.

COPD patients had a significantly higher proportion of comorbidities compared with controls, including hypertension (42.4 vs 26.9%), diabetes (16.1 vs 10.7%), coronary artery disease (21.2 vs 10.6%), heart failure (6.3 vs 1.9%), and chronic renal disease (6.5 vs 1.8%). COPD patients also had a more prevalent history of peptic ulcer disease than controls (22.1 vs 10.2%).

Over the 8-year follow-up period, 2.3% of study participants experienced ulcer bleeding, 65.3% of whom were in the COPD group. Overall, COPD patients had a significantly higher rate of peptic ulcer bleeding compared with controls.

After adjusting for age, gender, underlying comorbidities, and ulcerogenic medication, COPD was found to be an independent risk factor for ulcer bleeding (adjusted hazard ratio [aHR]=1.93).

Significant risk factors for ulcer bleeding in COPD patients as revealed by multivariate analysis included age over 65 years (aHR=2.65), male gender (aHR=1.62), hypertension (aHR=1.28), diabetes (aHR=1.38), heart failure (aHR=1.66), chronic renal disease (aHR=1.30), history of peptic ulcer disease (aHR=1.21), and use of NSAIDs (aHR=1.67).

The researchers say there may be several reasons why COPD increases the risk for ulcer bleeding. These could include the production of reactive oxygen species that may damage gastric or small intestinal mucosa through exposure to oxidative stress secondary to chronic hypoxia; the presence of other smoking-related chronic diseases; the use of antiplatelet agents that increase ulcer bleeding risk; and chronic steroid use that can delay peptic ulcer healing.

The findings are published in Alimentary Pharmacology and Therapeutics.

By Ingrid Grasmo

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