Cirrhotic Patients and Risk of Peptic Ulcer Bleeding
Cirrhotic Patients and Risk of Peptic Ulcer Bleeding
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.
Cirrhotic patients often developed upper gastrointestinal bleeding due to portal hypertension, as well as subsequent gastro-oesophageal variceal haemorrhage. Previous studies have shown that cirrhotic patients have a higher prevalence of peptic ulcer disease (PUD) than the general population. Clinically, advanced cirrhosis (Child–Pugh classes B and C) is an important factor associated with PUD in cirrhotic patients.
To date, very few large population-based studies have evaluated the occurrence of peptic ulcer bleeding (PUB) in cirrhotic patients in terms of comorbidity and ulcerogenic medication when compared to controls, or have identified risk factors for PUB in these cirrhotic patients. Taiwan is a hyperendemic area of liver diseases. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the two major aetiologies of liver diseases in Taiwan. This nationwide population-based cohort study was conducted to investigate the association between cirrhosis and PUB, and to identify possible risk factors of PUB in cirrhotic patients.
Abstract and Introduction
Abstract
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.
Introduction
Cirrhotic patients often developed upper gastrointestinal bleeding due to portal hypertension, as well as subsequent gastro-oesophageal variceal haemorrhage. Previous studies have shown that cirrhotic patients have a higher prevalence of peptic ulcer disease (PUD) than the general population. Clinically, advanced cirrhosis (Child–Pugh classes B and C) is an important factor associated with PUD in cirrhotic patients.
To date, very few large population-based studies have evaluated the occurrence of peptic ulcer bleeding (PUB) in cirrhotic patients in terms of comorbidity and ulcerogenic medication when compared to controls, or have identified risk factors for PUB in these cirrhotic patients. Taiwan is a hyperendemic area of liver diseases. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the two major aetiologies of liver diseases in Taiwan. This nationwide population-based cohort study was conducted to investigate the association between cirrhosis and PUB, and to identify possible risk factors of PUB in cirrhotic patients.
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