Low-dose aspirin is a prominent cause of bleeding ulcers in patients who underwent emergency endoscopy.
OBJECTIVE
This study aimed to clarify the current situation of bleeding peptic ulcers and examined the temporal changes in the pathogenic mechanisms requiring emergency endoscopy.


METHODS
Study subjects were 285 bleeding peptic ulcer patients who received emergency endoscopy in Saga Medical School Hospital between 2000 and 2007. The ratios of H. pylori infection, NSAID use and low-dose aspirin use were analyzed for differences between the two periods by chi-square test. Logistic regression analysis was used to investigate factors such as patient characteristics that influenced the differences between each period.


RESULTS
A total of 221 (77.5%) patients were identified as H. pylori-positive. One hundred (35.1%) patients reported a history of NSAID use within 4 weeks. Among NSAID users, 41 patients received daily low-dose aspirin. One hundred forty-one patients had bleeding ulcers in 2000-2003 and 144 patients in 2004-2007. The odds ratio (OR) between the periods was 0.806 (95% CI, 0.461-1.409) for H. pylori infection and 1.590 (95% CI, 0.973-2.598) for NSAID usage. In contrast, the proportion of patients who took low-dose aspirin was 9.9% in the first period and 18.8% in the second period, and the difference was statistically significant (OR 2.093; 95% CI, 1.047-4.185). Logistic regression analysis revealed that cardiovascular disease and cerebral vascular disease were associated with aspirin use.


CONCLUSIONS
This study indicates that the causes of bleeding ulcers are changing, and the increasing use of low-dose aspirin might become a major cause of bleeding ulcers.
Department of Internal Medicine, Saga Medical School, Saga, Japan.
Masayuki
M
Nakayama
Ryuichi
R
Iwakiri
Megumi
M
Hara
Hibiki
H
Ootani
Ryo
R
Shimoda
Seiji
S
Tsunada
Hiroyuki
H
Sakata
Kazuma
K
Fujimoto
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001241:Aspirin / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy; D002561:Cerebrovascular Disorders / Q000188:drug therapy; D016009:Chi-Square Distribution; D004632:Emergency Medical Services; D016099:Endoscopy, Gastrointestinal; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000209:etiology*; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin