title: The risk of acute major upper gastrointestinal bleeding among users of aspirin and ibuprofen at various levels of alcohol consumption.
abstract: OBJECTIVE
  Major upper gastrointestinal bleeding (UGIB) is the most important adverse effect of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Alcoholic beverages also precipitate UGIB. This analysis was conducted to evaluate whether the deleterious effects of NSAIDs are further increased among drinkers.
  
  
  METHODS
  An interview-based, case-control study was conducted in the U.S. and Sweden; 1224 patients hospitalized with acute major UGIB due to newly occurring peptic ulcer or gastritis were compared to 2945 neighbor controls.
  
  
  RESULTS
  Compared with those who drank less than one drink/wk, the relative risk of acute UGIB increased with increasing alcohol consumption, rising to 2.8 among those who drank > or = 21 drinks/wk. Among current drinkers, the relative risk of acute UGIB due to the use of aspirin was raised at all levels of alcohol consumption; the estimate for aspirin taken at least every other day (regular use) at doses of > 325 mg among all current drinkers combined was 7.0; for regular use at lower doses, the corresponding estimate was 2.8, and for any occasional use, it was 2.4. All estimates were statistically significant. Data for ibuprofen were more limited, but the relative risk estimates did not appear to vary consistently with level of alcohol consumption. For regular use (all doses combined), the estimate among all drinkers combined was significantly elevated, at 2.7; occasional ibuprofen use was not associated with UGIB (1.2). There were insufficient data to evaluate other NSAIDs according to alcohol consumption.
  
  
  CONCLUSIONS
  The findings suggest that acute UGIB is similarly associated with the use of the two most common nonprescription NSAIDs, aspirin and ibuprofen, at all levels of alcohol consumption. As heavy alcohol intake independently increases the risk, the incidence of UGIB is highest among persons who are both heavy drinkers and users of aspirin or ibuprofen.
authors.affiliation: Slone Epidemiology Unit, School of Public Health, Boston University School of Medicine, Brookline, Massachusetts, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Kaufman
authors.forename: J P
authors.initials: JP
authors.lastname: Kelly
authors.forename: B E
authors.initials: BE
authors.lastname: Wiholm
authors.forename: A
authors.initials: A
authors.lastname: Laszlo
authors.forename: J E
authors.initials: JE
authors.lastname: Sheehan
authors.forename: R S
authors.initials: RS
authors.lastname: Koff
authors.forename: S
authors.initials: S
authors.lastname: Shapiro
mesh_terms: D000208:Acute Disease; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D004381:Duodenal Ulcer / Q000150:complications; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D005756:Gastritis / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013276:Stomach Ulcer / Q000150:complications
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000431:Ethanol; D001241:Aspirin; D007052:Ibuprofen