title: Prospective survey for the etiology and outcome of peptic ulcer bleeding: a community based study in southern Taiwan.
abstract: OBJECTIVE
  Helicobacter pylori infection and drugs are the two major risk factors for peptic ulcer bleeding. The role of these two factors may change with changes in the prevalence of H pylori and use of NSAIDs. This study aimed to determine the cause, endoscopic features, and outcome of peptic ulcer bleeding in a community hospital in southern Taiwan.
  
  
  METHODS
  Patients who received esophagogastroduodenoscopy on arrival at the emergency department and were found to have actively bleeding ulcers or ulcers with stigmata of recent hemorrhage were included. H pylori infection was documented by the rapid urease test, histology, and/or C-13 urease breath test. Medication history, comorbidities, requirement for endoscopic therapy, blood transfusion, hospitalization days, and rebleeding rates were analyzed.
  
  
  RESULTS
  A total of 204 patients were enrolled with a mean age of 64.8 ± 15.2 years, with 58.3% of the subjects being female. There were 62 patients (30.4%) with H pylori infection only, 40 patients (19.6%) with drug use only, 67 patients (32.8%) with H pylori infection and drug use, and 37 patients (17.2%) without H pylori or drug use. A total of 107 patients (52.5%) were found to have had drug exposure. Drug exposure had an odds ratio (OR) of 2.34 [95% Confidence Interval (CI) = 1.30-4.20] for gastric ulcer bleeding and H pylori had an OR of 2.64 (95% CI = 1.17-5.97) for combined gastric and duodenal ulcer bleeding. The mean hospitalization period was 5.7 ± 4.0 days and the overall re-bleeding rate was 4.0%. The H pylori negative and drug negative subjects needed more endoscopic therapy (p < 0.05).
  
  
  CONCLUSIONS
  Drug use, especially NSAIDs, aspirin, and clopidogrel has become an important cause of peptic ulcer bleeding in southern Taiwan.
authors.affiliation: Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chi-Yang
authors.initials: CY
authors.lastname: Chang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Ching-Tai
authors.initials: CT
authors.lastname: Lee
authors.forename: Jau-Chung
authors.initials: JC
authors.lastname: Hwang
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Tai
authors.forename: Daw-Shyong
authors.initials: DS
authors.lastname: Perng
authors.forename: Chih-Wen
authors.initials: CW
authors.lastname: Lin
authors.forename: Wen-Lun
authors.initials: WL
authors.lastname: Wang
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D005260:Female; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D013624:Taiwan
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal