title: Increased incidence of herpes zoster in adult patients with peptic ulcer disease: a population-based cohort study.
abstract: BACKGROUND
  Peptic ulcer disease (PUD) has been linked to immunological dysfunctions and malnutrition—both are predictors of herpes zoster(HZ). We hypothesized that PUD patients might have a greater risk for developing HZ.
  
  
  METHODS
  Using the longitudinal National Health Insurance Research Database, we conducted a retrospective population-based cohort study to evaluate the incidence of HZ in adult PUD patients and controls matched by age and gender. Kaplan-Meier analysis and Cox regression were conducted to compare differences in the development of HZ. The effects of comorbidities on the risk of HZ and the associations between different risk factors of PUD and HZ were assessed by subgroup analyses.
  
  
  RESULTS
  We identified 41 229 adults PUD patients and 41 229 controls. Over an 8-year follow-up, the cumulative incidence of HZ in PUD patients(11.76/1000 person-years) was significantly higher than controls(6.56/1000 person-years) (P<0.001, by log-rank test). After adjusting for potential confounders, PUD was an independent predictor for HZ (adjusted hazard ratio: 1.77, 95% confidence interval 1.64–1.91, P<0.001). Major risk factors of PUD were non-selective nonsteroidal anti-inflammatory drugs (nsNSAID) usage and Helicobacter pylori infection. Subgroup analyses revealed that PUDis an independent predictor of HZ after excluding the potential confounding effects of the comorbidities; PUD associated with the combination of nsNSAID usage and Helicobacter pylori infection leads to greatest risk of HZ.
  
  
  CONCLUSIONS
  Adults with PUD are at increased risk of HZ independently compared with the general population. Further studies are required to clarify the nature of the associations between HZ and PUD.
authors.forename: Jen-Yin
authors.initials: JY
authors.lastname: Chen
authors.forename: Tain-Junn
authors.initials: TJ
authors.lastname: Cheng
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Chang
authors.forename: Kuo-Mao
authors.initials: KM
authors.lastname: Lan
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Ming-Jen
authors.initials: MJ
authors.lastname: Sheu
authors.forename: Su-Feng
authors.initials: SF
authors.lastname: Tseng
authors.forename: Miao-Lin
authors.initials: ML
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D016481:Helicobacter Infections / Q000453:epidemiology; D016480:Helicobacter pylori; D006562:Herpes Zoster / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal