NSAID's. Risk factors for peptic ulcer bleeding. Experience from a dedicated gastrointestinal bleeding unit

Aim: To identify risk factors for PUD and significant GI bleeding in patients using NSAID's in Northeast Scotland.

Methods: A retrospective audit of NSAID related GI bleeds admitted to a dedicated unit. A history of PUD, H. pylori therapy, prophylaxsis and current medications was recorded. Emergency endoscopy was performed (<24 hrs), findings documented and Hp a CLO taken. Exclusions: bleeding diatheses, anti-coagulation, prior surgery, previous NSAID complications, Aspirin only.

Results: 89 patients with NSAID's and GI bleeding were admitted in 1 year, 35 (44%) men and 42 (53%) >65yrs. Hp status was available in 52 (65%) cases, 17 (33%) (+)ive. 45 (57%) had PUD, all with recent bleeding, 22 (28%) DU and 23 (29%) GU's. PUD was not associated with age or gender. H. pylori was significantly associated with PUD; p<0.05. 10 (13%) Subjects had past PUD and 19 (24%) regularly took PPI's. Neither PPI's nor past PUD was associated with PUD. Only 4 patients with past PUD were receiving prophylaxsis and none had eradication therapy.

Conclusions: These findings are not consistent with previous reports and suggests that NSAID related bleeding ulcers occur independently of PPI use, previous PUD or Hp therapy. Our findings support a key role for H. pylori in NSAID related PUD and hemorrhage with a RR of 3.85.

	Hp (+)ive	Prior PUD	PPI
Non PUD	4/20 (20%)	4/35	9/35
PUD	13/32 (41%)	6/45	10/45