title: Risk factors for peptic ulcer bleeding in terms of Helicobacter pylori, NSAIDs, and antiplatelet agents.
abstract: OBJECTIVE
  The role of the Helicobacter pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiplatelet agents in the risk of peptic ulcer bleeding has not yet been established. This study was performed to identify the risk factors for peptic ulcer bleeding compared with non-bleeding peptic ulcer disease (PUD).
  
  
  METHODS
  A total of 475 patients, 265 with bleeding PUD and 210 with non-bleeding PUD were consecutively recruited. H. pylori status was determined by histology, rapid urease test, and culture. Exposure to NSAIDs, aspirin, and antiplatelet agents (clopidogrel and ticlopidine) within 4 weeks was obtained.
  
  
  RESULTS
  Compared with non-bleeding PUD, bleeding PUD had a higher proportion of male gender and current smoking, alcohol drinking, history of aspirin/antiplatelet use, and history of PUD. Whereas the proportion of H. pylori infection and history of H. pylori eradication in bleeding PUD were significantly lower than that in non-bleeding PUD. In multivariate analysis, male gender (OR 1.78, 95% CI 1.10-2.89), drinking alcohol (OR 2.08, 95% CI 1.29-3.14), aspirin/antiplatelet use (OR 2.35, 95% CI 1.45-3.82), and history of PUD (OR 2.46, 95% CI 1.36-4.46) remained independent risk factors for bleeding PUD. When H. pylori status and aspirin/antiplatelet agent use were combined, highest risk of bleeding peptic ulcers was found among H. pylori-negative patients with a history of aspirin/antiplatelet agent use (OR 3.03 95% CI 1.48-6.18) compared with H. pylori-positive patients with no history of aspirin/antiplatelet agent use.
  
  
  CONCLUSIONS
  Patients with H. pylori-negative peptic ulcers who continuously took aspirin or antiplatelet agents had the highest peptic ulcer bleeding risk.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung Mook
authors.initials: JM
authors.lastname: Kang
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Byoung Hwan
authors.initials: BH
authors.lastname: Lee
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Park
authors.forename: Hyun Jin
authors.initials: HJ
authors.lastname: Jo
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Shin
authors.forename: Sang Hyub
authors.initials: SH
authors.lastname: Lee
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.forename: Jin Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jeong
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
authors.forename: In Sung
authors.initials: IS
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000382:microbiology*; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D010975:Platelet Aggregation Inhibitors