title: Accommodation in a refugee shelter as a risk factor for peptic ulcer bleeding after the Great East Japan Earthquake: a case-control study of 329 patients.
abstract: BACKGROUND
  We have reported that the total number of peptic ulcers (PUs) had increased 1.5-fold after the Great East Japan Earthquake compared with those of the previous year, and that hemorrhagic ulcers were more prominently increased by 2.2-fold. The aim of this study is to determine the risk factors for bleeding ulcers after the Great East Japan Earthquake.
  
  
  METHODS
  Clinical data of all peptic ulcer subjects endoscopically detected at the 7 major hospitals in the middle of the stricken area during the 3 months after the earthquake were retrospectively collected. Based on endoscopic and laboratory findings, peptic ulcer cases were divided into 227 bleeding ulcer cases and 102 non-bleeding controls. Other than ordinary risk factors for bleeding ulcers, the refugee shelter was included in the analysis as a unique confounder after the earthquake. Multiple logistic regression analyses were used to adjust for potential confounders.
  
  
  RESULTS
  Eighty-seven (27%) of 329 PUs emerged from refuge shelters, and the majority (76 of 87) of PUs occurring in such shelters was the bleeding type. Multivariate regression showed that residence in a shelter was a strong risk factor for ulcer bleeding with OR (95% CI): 4.4 (2.1-9.6, p < 0.0001), independent of the progressiveness of ulcer diseases.
  
  
  CONCLUSIONS
  Accommodation in a refugee shelter can be a strong risk factor for ulcer bleeding after a large-scale disaster. Since acid-suppressive drugs are supposed to decrease the risk for stress-induced ulcer bleeding, our results will encourage effective use of a limited medical resource in such catastrophic events.
authors: Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aobaku, Sendai, 980-8574, Japan.
authors: Takeshi
authors: T
authors: Kanno
authors: Kastunori
authors: K
authors: Iijima
authors: Tomoyuki
authors: T
authors: Koike
authors: Yasuhiko
authors: Y
authors: Abe
authors: Norihiro
authors: N
authors: Shimada
authors: Tatsuya
authors: T
authors: Hoshi
authors: Nozomu
authors: N
authors: Sano
authors: Motoki
authors: M
authors: Ohyauchi
authors: Hirotaka
authors: H
authors: Ito
authors: Tomoaki
authors: T
authors: Atsumi
authors: Hidetomo
authors: H
authors: Konishi
authors: Sho
authors: S
authors: Asonuma
authors: Tooru
authors: T
authors: Shimosegawa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D055866:Earthquakes; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012036:Refugees / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors