title: Alcohol Abuse Increases Rebleeding Risk and Mortality in Patients with Non-variceal Upper Gastrointestinal Bleeding.
abstract: BACKGROUND
  No current data are available on rebleeding and mortality risk in patients who use alcohol excessively and are admitted for non-variceal upper gastrointestinal bleeding (NVUGIB). This information could help in planning interventions and follow-up protocols for these patients.
  
  
  OBJECTIVE
  This study provides contemporary data on the long-term outcome after first-time NVUGIB in alcohol abusers (AAs) compared to non-abusers (NAs).
  
  
  METHODS
  Consecutive patients hospitalized for their first acute gastrointestinal bleeding from 2009 through 2011 were retrospectively recorded and categorized as AA or NA. Risk factors for one-year mortality and rebleeding were identified, and patients were further monitored for long-term mortality until 2015.
  
  
  RESULTS
  Alcohol abuse was identified in 19.7% of patients with NVUGIB (n = 518). The one-year rebleeding rate was 16.7% in AAs versus 9.1% in NAs (P = 0.027). Alcohol abuse was associated with a twofold increase in rebleeding risk (P = 0.025); the risk especially increased 6 months after the initial bleeding. The study groups did not differ significantly in 30-day (6.0%) or one-year mortality rates (20.5%). However, there was a tendency for higher overall mortality in AAs than NAs after adjustment of comorbidities.
  
  
  CONCLUSIONS
  AAs with NVUGIB are at high risk of rebleeding, and mortality is increased in AA patients. A close follow-up strategy and long-term proton pump inhibitor therapy are recommended for AA patients with peptic ulcer or esophagitis.
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, KYS, Finland. jkarkkai@gmail.com.|Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland. jkarkkai@gmail.com.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Kärkkäinen
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, KYS, Finland.|Emergency Department, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Miilunpohja
authors.affiliation: Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Tuomo
authors.initials: T
authors.lastname: Rantanen
authors.affiliation: School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Jenni M
authors.initials: JM
authors.lastname: Koskela
authors.affiliation: Assessment of Pharmacotherapies, Finnish Medicines Agency, Kuopio, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Jyrkkä
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, KYS, Finland.|School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hartikainen
authors.affiliation: Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland.|School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Paajanen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D041742:Upper Gastrointestinal Tract / Q000473:pathology*
keywords: Alcohol abuse; Alcoholism; Gastrointestinal bleeding; Gastrointestinal hemorrhage; Mortality; Rebleeding