Acute upper gastrointestinal bleeding: comparison between recent users and nonusers of nonsteroidal anti-inflammatory drugs.
OBJECTIVE
To determine clinical, endoscopic, and outcome differences between recent users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs) presenting with upper gastrointestinal bleeding (UGIB).


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.
Adamopoulos
A
A
Third University Dept. of Internal Medicine, Sotiria General Hospital, Athens, Greece. gpp@hol.gr
Efstathiou
S
S
Tsioulos
D
D
Tsami
A
A
Mitromaras
A
A
Mountokalakis
T
T
D000368:Aged; D000437:Alcoholism / Q000150:complications; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005756:Gastritis / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged
D000894:Anti-Inflammatory Agents, Non-Steroidal