title: Short-term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population-based case-crossover study.
abstract: BACKGROUND
  Controversy exists regarding glucocorticoids therapy and the risk of peptic ulcer bleeding (PUB).
  
  
  OBJECTIVE
  The present study was undertaken to determine whether short-term use of glucocorticoids is associated with the occurrence of peptic ulcer bleeding.
  
  
  METHODS
  The records of adult patients hospitalised for newly diagnosed peptic ulcer bleeding from 2000 to 2012 were retrieved from the Taiwan National Health Insurance Research Database, a nationwide population-based registry system. The association between systemic glucocorticoids usage and peptic ulcer bleeding was determined with a conditional logistic regression model comparing cases and controls during time windows of 7, 14 and 28 days using a case-crossover design.
  
  
  RESULTS
  Of the 8894 enrolled patients, the adjusted self-matched odds ratios for peptic ulcer bleeding after exposure to the glucocorticoids were 1.37 (95% CI: 1.12-1.68, P = 0.003) for the 7-day window, 1.66 (95% CI: 1.38-2.00, P < 0.001) for the 14-day window and 1.84 (95% CI: 1.57-2.16, P < 0.001) for the 28-day window. Moderate to high, but not low dose glucocorticoids (methylprednisolone <4 mg/day or its equivalence) were associated with an increased risk of peptic ulcer bleeding. Concomitant use of a nonselective nonsteroidal anti-inflammatory drug (NSAID) or aspirin further elevated the risk. However, it does not eliminate the effect of underlying diseases flare-up that may have placed the patients at risk for peptic ulcer bleeding in this kind of study design.
  
  
  CONCLUSIONS
  Short-term (7-28 days) exposure to glucocorticoids is significantly associated with peptic ulcer bleeding; this risk seems dose-dependent and is higher when nonselective NSAIDs or aspirin are used concurrently.
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: C-L
authors.initials: CL
authors.lastname: Tseng
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.
authors.forename: Y-T
authors.initials: YT
authors.lastname: Chen
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: C-J
authors.initials: CJ
authors.lastname: Huang
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: J-C
authors.initials: JC
authors.lastname: Luo
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Y-L
authors.initials: YL
authors.lastname: Peng
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: D-F
authors.initials: DF
authors.lastname: Huang
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, Endoscopic Center for Diagnosis and Therapy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Hou
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: H-C
authors.initials: HC
authors.lastname: Lin
authors.affiliation: Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: F-Y
authors.initials: FY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D018592:Cross-Over Studies; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D012107:Research Design; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D005938:Glucocorticoids; D001241:Aspirin