Incidence Of Upper Gastrointestinal Bleeding Research Articles

Upper gastrointestinal bleeding and the changing use of COX‐2 non‐steroidal anti‐inflammatory drugs and low‐dose aspirin

Rofecoxib was withdrawn in 2004. To assess the incidence of upper gastrointestinal bleeding in the context of the changing use of cyclo-oxygenase-2 non-steroidal anti-inflammatory drugs and low-dose aspirin. We examined the characteristics of patients developing upper gastrointestinal bleeding in a defined population in south-west Scotland. The primary comparisons were made between two calendar years, preceding and following the withdrawal of rofecoxib. The overall incidence of upper gastrointestinal bleeding rose from 98.7 in 2002 to 143 per 10(5) of the population per annum in 2005 (chi(2) = 21.1; P < 0.001). The rise in the incidence was associated with using low-dose aspirin, from 26.6 to 38.4 per 10(5) (chi(2) = 5.4; P = 0.02), other antithrombotic drugs, from 12.1 to 30.2 per 10(5) (chi(2) = 19.6; P < 0.001), and excess alcohol, from 23.5 to 36.4 per 10(5) (chi(2) = 7.1; P = 0.008), but insignificantly with using non-steroidal anti-inflammatory drugs, from 13.3 to 16.1 per 10(5) (chi(2) = 0.64; P = 0.4). After adjustment for the concomitant use of these drugs, there was no significant trend in the incidence of upper gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs over the period of 1996-2005. The rise in the incidence of upper gastrointestinal bleeding was weakly related to the change in use of non-steroidal anti-inflammatory drugs. Instead, it probably reflected the increasing use of low-dose aspirin, other antithrombotic drugs and alcohol.

Clinical impact of selective serotonin reuptake inhibitors therapy with bleeding risks

The selective serotonin reuptake inhibitors (SSRIs) are extensively used for the treatment of multiple psychiatric conditions. In vitro and ex vivo data with these agents indicate they may have varying degrees of antiplatelet activity via multiple receptors. Reports of bleeding in patients receiving SSRIs appeared soon after their introduction. A review of the literature suggests SSRI therapy may increase the risk of bleeding especially with concomitant aspirin or nonsteroidal anti-inflammatory agents. Clinicians should exercise caution when prescribing these agents in high risk patients and maintain awareness of the potential contribution of SSRIs to unexplained bleeding episodes.

Upper Gastrointestinal Bleeding After Hip and Knee Arthroplasty

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants increases the risk of upper gastrointestinal bleeding. This article assesses its incidence in patients undergoing hip and knee arthroplasty. A single-center, retrospective study was conducted on 100 consecutive hip and 100 consecutive knee arthroplasties performed at the Victoria Infirmary, Glasgow, between 1998 and 2000. Sixty-three percent of patients were women with a mean age of 74. Fifty-four percent of patients received NSAIDs and all patients received anticoagulants perioperatively. Four and a half percent of patients had upper gastrointestinal bleeding postoperatively. We believe that the incidence of upper gastrointestinal bleeding as a complication is underestimated and recommend gastro-protective agents in the perioperative period for patients on NSAIDs.

Incidence and predictors of upper gastrointestinal bleeding in patients receiving low-dose aspirin for secondary prevention of cardiovascular events in patients with coronary artery disease

The use of low-dose aspirin to prevent cardiovascular disease events is well established. However, the incidence and predictors of upper gastrointestinal bleeding (UGIB) with its use are unknown. We studied prospectively the incidence and outcome of peptic ulceration in low-dose aspirin users. A total of 991 patients with coronary artery disease (CAD) on low-dose aspirin were prospectively followed-up for two years for the occurrence and clinical features of first hospitalized episode of UGIB. UGIB had a bimodal presentation with 45% occurring within four months of aspirin initiation and had an overall prevalence of 1.5% per year. There was no UGIB-related death. Hypertension (OR = 4.6, 95%CI 1.5-14.7, P = 0.009), history of peptic ulceration (OR = 3.1, 95%CI 1.1-9.0, P = 0.039), tertiary education (OR = 3.08, 95%CI 1.1-9.0, P = 0.039) and higher lean body mass (P = 0.016) were independent factors associated with UGIB. Use of nitrate did not reduce UGIB. The incidence of UGIB in patients with CAD on long-term low-dose aspirin is low, but is accompanied with significant morbidity. With prolonged use of aspirin, UGIB continues to be a problem for those with risk factors and especially in patients with a history of peptic ulcers, in which UGIB tends to occur early after aspirin therapy.

High risk factors of upper gastrointestinal bleeding after neurosurgical procedures

To analyze high risk factors of postoperative upper gastrointestinal (GI) bleeding after neurosurgery so as to give guidance for prevention of GI bleeding. A questionnaire was developed to investigate the medical records of 1500 patients who were hospitalized and underwent neurosurgical operations in 1997. Logistic regression analysis was made. 1430 valid questionnaires were obtained. Postoperative upper GI bleeding occurred in 75 patients (5.24%). The incidence of upper GI bleeding were 6.64% (54/813) in the male patients and 3.40% (21/617) in the female persons (P = 0.007); 9.88% (41/415) in those aged > 50 and 3.35% in those aged < or = 50 (P = 0.001). Glasgow Coma Score less than 10 pre- and post-operation, the incidence of upper GI bleeding was more than 17.5% (14/80, pre-operation GCS 7-10) and 20.9% (14/67, pre-operation GCS 3-6), and 20.25% (16/79, first day of post-operation GCS 7-10) and 23.75% (19/80, first day of post-operation GCS 3-6). The incidence of upper GI bleeding of the patients with intracerebral hematoma, intraventricular hemorrhage, subdural hematoma, and extradural hematoma were 15.7%, 10.0%, 6.00%, and 2.94% respectively (P = 0.02). The incidence of upper GI bleeding of the patients with tumors of fourth ventricle of cerebrum, brainstem, cerebral hemisphere, and sellar hypothalamus were 15.79% (3/19), 7.89%, 5.71%, and 3.74% respectively. In the emergent cases, the incidence of upper GI bleeding was higher in those with hypertension. The incidence of upper GI bleeding was 5.46% in the patients undergoing adrenocortical hormone treatment, significantly higher than that in those who did not receive such treatment (2.13%). Patients who are at high risk of developing postoperative upper GI bleeding including that: age greater than 50 years; male; Glasgow Coma Score less than 10 pre and post operation; The lesion was located in brain stem and forth ventricle; Hypertensive cerebral hemorrhage; Intracerebral and intraventricular hemorrhagic brain trauma; Postoperative pneumonia, brain edema, encephalic high pressure, pyogenic infection of the central nervous system and other postoperative complications. The mortality of patients with postoperative upper GI bleeding was evidently higher than that of the patients without postoperative upper GI bleeding.

Influencia de los factores climáticos en la incidencia de hemorragia digestiva alta

Several studies have suggested the existence of seasonal variation in the incidence of upper gastrointestinal bleeding (UGB). However, the role of climatic factors has not been elucidated. The aim of the present study was to investigate the role of these factors in the incidence of UGB secondary to esophageal varices (EV), gastric ulcer (GU), and duodenal ulcer (DU). Based on the use of the Minimum Data Set and the International Classification of Diseases, cases of endoscopically-confirmed UGB secondary to EV, GU and DU were retrospectively included (1998-2001). The incidence of UGB was correlated with daily climatic factors (temperature, atmospheric pressure, humidity, direction and speed of wind) in Jerez de la Frontera (Spain) during the study period. A total of 499 patients were included (GU = 192, DU = 199, EV = 108). No significant differences were found in the monthly or seasonal incidence of UGB. Episodes of UGB were grouped according to the climatic conditions present on the day of admission. No significant relationship was found between UGB and any of the daily climatic factors studied. The results of our study do not support the existence of a seasonal pattern in the incidence of UGB secondary to GU, DU or EV and allow us to conclude that, in our geographical area, these factors are not involved in episodes of bleeding.

Clinical Care Pathway for Nonvariceal Upper GI Bleeding

The annual cost of treating nonvariceal acute upper gastrointestinal bleeding (UGIB) in the U.S. exceeds $2.5 billion. Despite the high incidence of UGIB, there is wide variation among hospitals in the treatment of the disease, including the timing of endoscopy, the use of acid reduction medication, and rates of hospitalization and ICU care. A disease management team at University Hospitals of Cleveland developed clinical care …

Mukosaprotektive Therapie unter Langzeitmedikation mit nichtsteroidalen Antirheumatika

Due to the extraordinary high prevalence of peptic lesions in the upper gastrointestine in the long-term treatment with nonsteroidal anti-inflammatory drugs, a prophylaxis in patients belonging to high-risk groups is essential. Misoprostol, proton pump inhibitors and histamine 2-receptor antagonists have been evaluated in prospective studies. The efficacy of Misoprostol is well documented, though its use in prevention is frequently limited due to side effects. Proton pump inhibitors are also well established, especially in the therapy of nonsteroidal anti-inflammatory drugs associated peptic ulcers and in consecutive secondary prevention. The histamine 2-receptor antagonist Famotidine in a high oral dosage is able to reduce the frequency of peptic lesions too, but not to the same degree as Misoprostol and proton pump inhibitors. It is very likely that helicobacter pylori eradication without any further mucosaprotective therapy will only decrease the incidence of upper gastrointestinal bleeding in low dose Aspirin application. In spite of controversial studies this eradication seems to be a useful additional therapy for ulcer prophylaxis in high risk groups. Selective Cyclooxygenase-2 inhibitors may become a promising alternative, from a pathophysiological perspective. However, to date there has been a lack of clear comparative studies with common nonsteroidal anti-inflammatory drugs plus mucosaprotecting agents. Daily therapy costs are higher with a Cyclooxygenase-2 inhibitor than using the traditional nonsteroidal anti-inflammatory drugs together with either proton pump inhibitors, histamine 2-receptor antagonists or Misoprostol--a fact that should be considered in primary therapeutic decisions. In the following review we will present the most important results of the different prophylactic and therapeutic modalities. On the basis of placebo-controlled, prospective studies on the one hand and the recommendations of the scientific societies on the other, a guideline for daily clinical practice will be suggested.

Risk of upper gastrointestinal bleeding in patients taking low-dose aspirin for the prevention of cardiovascular diseases.

Most patients with vascular-occlusive diseases benefit from low-dose aspirin (75-325 mg/day). However, they have an increased risk of upper gastrointestinal bleeding (UGIB). To analyse the incidence and factors influencing the occurrence of UGIB in patients taking low-dose aspirin for the prevention of cardiovascular diseases outside clinical trials. We studied 903 consecutive patients discharged on low-dose aspirin from the Cardiology Department of a general hospital. Data were collected from medical charts and structured telephone interviews. Forty-one patients (4.5%) presented with UGIB requiring hospitalization during follow-up (45 +/- 22 months). The incidence of UGIB was uniform during follow-up (1.2 UGIB per 100 patient years). Multivariate analysis showed that a history of peptic ulcer or UGIB [risk ratio: 3.1, 95% CI: (1.5-6.5)] and aspirin dose (per 100 mg/day) [1.8 (1.5-2.9)] was associated with higher risk of UGIB. On the other hand, antisecretory [0.22 (0.07-0.75)] and nitrovasodilator drugs [0.73 (0.55-0.96)] were associated with a decreased risk. Cardiovascular patients on long-term low-dose aspirin have a stable risk of major UGIB, which is higher than published controlled clinical trials. Antisecretory and nitrovasodilator drugs protect from UGIB, whereas previous peptic ulcer or UGIB and higher doses of aspirin increase the risk.

Incidence of serious upper gastrointestinal bleeding/perforation in the general population:: Review of epidemiologic studies

The object of this study was to quantify the incidence of serious upper gastrointestinal complications among nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs). Systematic review of epidemiologic studies published between 1980 and 2000 that provided data on the incidence of upper gastrointestinal bleeding, perforation, or other upper gastrointestinal tract event resulting in death, hospitalization, or visit to a specialist among nonusers of nonsteroidal anti-inflammatory drugs. The authors calculated summary incidence rates and analyzed heterogeneity among results according to outcome definition, population characteristics, and methodology of primary studies. Forty-one population-based studies were reviewed, and 12 were included in the final analysis. Differences in outcome definitions accounted for much of the variability in incidence rate estimates reported in original studies. The pooled incidence rate estimate among nonusers of prescription NSAIDs per 1,000 person-years was 0.1 (95% confidence interval: 0.04–0.23) for perforations alone, 0.8 (0.58–0.68) for bleeding lesions alone, 0.9 (0.66–1.27) for bleeding or perforated lesions, and 1.0 (0.83–1.15) for serious gastrointestinal ulcer (complicated or without bleeding). Rates increased with age, and were approximately twice as high in men than in women. Epidemiologic studies based on automated data may slightly under- or overestimate the true incidence rate among nonusers of NSAIDs. Overall, the incidence rate of serious upper gastrointestinal complications was in the order of 1 per 1,000 person-years among nonusers of prescription NSAIDs.

Influence of climatic factors in the incidence of upper gastrointestinal bleeding.

Previous reports have indicated seasonal fluctuations in the incidence of peptic ulcer activity, but the reasons for the seasonal pattern are not clear. We assessed the seasonal incidence of hematemesis caused by peptic ulcers or gastroesophageal varices, and the correlations between those and climatic factors. We examined the number of cases of upper gastrointestinal (GI) bleeding caused by gastric ulcer (GU), duodenal ulcer (DU), or gastroesophageal varices (varix) diagnosed by urgent endoscopies between 1 January 1996 and 31 December 1999 in our hospital (Tokyo Metropolitan Bokutou Hospital). We evaluated the monthly and seasonal incidence of them and investigated correlations among the incidence and climatic factors. Four hundred and forty-one patients participated in this study, including 275 patients with GU (62.4%), 51 (11.6%) with DU, and 115 (26.0%) with varix. The number of cases of hematemesis caused by GU showed significant monthly and seasonal fluctuations (P = 0.0002, P = 0.0018): it decreased in summer and increased in autumn-winter. Moreover, there were inverse relations between the monthly number of cases of hematemesis caused by GU and the mean temperature (P = 0.0016) and vapor pressure (P = 0.0013), and a parallel relation to the mean atmospheric pressure (P = 0.0057). In contrast, the number of cases of hematemesis caused by DU and varices did not show any monthly or seasonal fluctuations. We found that the incidence of hematemesis because of GU had an inverse relationship to temperature and vapor pressure, and had a parallel relation to atmospheric pressure. Therefore, climatic factors may play an important role in hemorrhage from GU.

Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: Is specific prophylaxis in routine bypass procedures needed?

(1) To obtain a literature review concerning pathogenesis and incidence of stress ulceration (SU) in patients undergoing cardiac surgery. (2) To determine which methods are useful in the prevention of SU and to analyze whether SU prophylaxis by acid reduction is effective in patients undergoing cardiac surgery. Literature review from Medline and reference list of identified articles until 1999. SU and upper gastrointestinal bleeding (UGIB) in patients after cardiac surgery have been reported since 1957. All articles were retrospective reports. Definitions of SU and UGIB were variable. Ischemia, reperfusion injury, and endotoxemia were the main pathogenetic mechanisms in SU formation. Valve replacement, aortic cross-clamping and bypass time, nonpulsatile flow during bypass, reoperation, and inflammatory state were risk factors for UGIB. Randomized, controlled clinical trials concerning SU prophylaxis have not been performed. The overall incidence of UGIB was 0.45% (638 bleeds in 141,887 patients). In patients with known use of SU prophylaxis with histamine2-receptor antagonists or antacids, the incidence of UGIB was 0.35%, and in patients without these medications, the incidence of UGIB was 0.45% (p = 0.16). Pathogenesis and risk factors for SU and UGIB are summarized. A review of the literature showed that the incidence of UGIB in patients after cardiac surgery was low. A randomized, controlled trial concerning pharmacologic stress ulcer prophylaxis has not been performed. The available retrospective reports concerning pharmacologic stress ulcer prophylaxis do not support the routine use of histamine2-receptor antagonists.

Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: Is specific prophylaxis in routine bypass procedures needed?

Objectives (1) To obtain a literature review concerning pathogenesis and incidence of stress ulceration (SU) in patients undergoing cardiac surgery. (2) To determine which methods are useful in the prevention of SU and to analyze whether SU prophylaxis by acid reduction is effective in patients undergoing cardiac surgery.Design Literature review from Medline and reference list of identified articles until 1999.Measurements and Main Results SU and upper gastrointestinal bleeding (UGIB) in patients after cardiac surgery have been reported since 1957. All articles were retrospective reports. Definitions of SU and UGIB were variable. Ischemia, reperfusion injury, and endotoxemia were the main pathogenetic mechanisms in SU formation. Valve replacement, aortic cross-clamping and bypass time, nonpulsatile flow during bypass, reoperation, and inflammatory state were risk factors for UGIB. Randomized, controlled clinical trials concerning SU prophylaxis have not been performed. The overall incidence of UGIB was 0.45% (638 bleeds in 141,887 patients). In patients with known use of SU prophylaxis with histamine2-receptor antagonists or antacids, the incidence of UGIB was 0.35%, and in patients without these medications, the incidence of UGIB was 0.45% (p = 0.16).Conclusions Pathogenesis and risk factors for SU and UGIB are summarized. A review of the literature showed that the incidence of UGIB in patients after cardiac surgery was low. A randomized, controlled trial concerning pharmacologic stress ulcer prophylaxis has not been performed. The available retrospective reports concerning pharmacologic stress ulcer prophylaxis do not support the routine use of histamine2-receptor antagonists.

Helicobacter pylori infection: a risk factor for upper gastrointestinal bleeding after cardiac surgery?

To determine the prevalence of Helicobacter pylori (H. pylori) in critically ill patients who develop upper gastrointestinal bleeding after cardiac surgery in relation to other risk factors. Prospective, single center, cohort study. Surgical intensive care unit in a university hospital. None. Over a 1-yr period, all consecutive patients with upper gastrointestinal hemorrhage from the stomach or duodenum were studied for H. pylori infection by serology. Additionally, the need for mechanical ventilation over 48 hrs, the duration cardiopulmonary bypass, and the aortic cross-clamp time were analyzed. For control, 229 patients with no evidence of gastrointestinal hemorrhage after cardiac surgery were studied. All patients received stress ulcer prophylaxis with ranitidine. Operations were performed on 2,956 patients during the study period. The incidence of upper gastrointestinal bleeding was 0.9%. Twenty (77%) of the 26 patients with upper gastrointestinal bleeding and 145 (63%) patients of the control group had serologic evidence for H. pylori infection (odds ratio, 1.9; 95% confidence interval 0.7-5.0; p = .2). Patients who required prolonged mechanical ventilation had a significantly greater risk for upper gastrointestinal bleeding (odds ratio, 22.1; 95% confidence interval 8.6-56.7; p<.001). Patients with upper gastrointestinal bleeding also had a significantly longer duration of cardiopulmonary bypass and aortic cross-clamp time (p<.001) H. pylori is not associated with upper gastrointestinal bleeding in critically ill patients who receive stress ulcer prophylaxis, whereas patients who require prolonged mechanical ventilation are at high risk. A prophylactic eradication of H. pylori is not justified.

The risk of acute major upper gastrointestinal bleeding among users of aspirin and ibuprofen at various levels of alcohol consumption

OBJECTIVE: Major upper gastrointestinal bleeding (UGIB) is the most important adverse effect of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Alcoholic beverages also precipitate UGIB. This analysis was conducted to evaluate whether the deleterious effects of NSAIDs are further increased among drinkers. METHODS: An interview-based, case-control study was conducted in the U.S. and Sweden; 1224 patients hospitalized with acute major UGIB due to newly occurring peptic ulcer or gastritis were compared to 2945 neighbor controls. RESULTS: Compared with those who drank less than one drink/wk, the relative risk of acute UGIB increased with increasing alcohol consumption, rising to 2.8 among those who drank ≥21 drinks/wk. Among current drinkers, the relative risk of acute UGIB due to the use of aspirin was raised at all levels of alcohol consumption; the estimate for aspirin taken at least every other day (regular use) at doses of >325 mg among all current drinkers combined was 7.0; for regular use at lower doses, the corresponding estimate was 2.8, and for any occasional use, it was 2.4. All estimates were statistically significant. Data for ibuprofen were more limited, but the relative risk estimates did not appear to vary consistently with level of alcohol consumption. For regular use (all doses combined), the estimate among all drinkers combined was significantly elevated, at 2.7; occasional ibuprofen use was not associated with UGIB (1.2). There were insufficient data to evaluate other NSAIDs according to alcohol consumption. CONCLUSIONS: The findings suggest that acute UGIB is similarly associated with the use of the two most common nonprescription NSAIDs, aspirin and ibuprofen, at all levels of alcohol consumption. As heavy alcohol intake independently increases the risk, the incidence of UGIB is highest among persons who are both heavy drinkers and users of aspirin or ibuprofen.

EVALUATION OF THE PATIENT WITH GASTROINTESTINAL BLEEDING: AN EVIDENCE BASED APPROACH

Gastrointestinal bleeding is a common and potentially life-threatening problem. The incidence of upper gastrointestinal bleeding (UGIB) is 40 to 150 episodes per 100,000 population per year. Mortality in large series is 6% to 10% for UGIB and has remained unchanged over the past 30 to 60 years. The incidence of hospitalization for acute lower gastrointestinal bleeding is about 20 to 27 episodes per 100,000 population per year, with a 200-fold increase with advancing age from the third to ninth decades. The mortality rate is 4% to 10% or higher. The evaluation of overt or acute gastrointestinal bleeding in the ED is reviewed here from the perspective of evidence-based medicine.

Gastrointestinal bleeding is common

EDITOR,--In their editorial on non-steroidal anti-inflammatory drugs and elderly patients D N Bateman and J G Kennedy erroneously quote an incidence of upper gastrointestinal bleeding of 210 cases per million people over 60 compared with 35 per million under 60,1 from a study carried out in our department.2 In fact, the annual incidences in our study were 10 times these—that is, 2100 and …

CONTINUOUS INFUSION RANITIDINE IN POSTOPERATIVE PEDIATRIC LIVER TRANSPLANT PATIENTS

The effects of ranitidine, an H(2)-receptor antagonist, on gastric pH, incidence of upper gastrointestinal hemorrhage and postoperative metabolic alkalosis were evaluated in 23 pediatric liver transplant recipients. Intragastric pH probes were inserted postoperatively and pH was monitored for 48 h. Ranitidine was infused for 48 h at 0.2 mg kg(minus sign1) h(minus sign1) (0.15 with renal impairment) and increased once by 0.05 mg kg(minus sign1) if the pH was less than 4.0 for 4 h. The pretreatment gastric pH was 2.1 plus minus 0.7; ranitidine infusion raised the pH to 6.8 plus minus 0.6 (p greater-than-or-equal 0.05). An intragastric pH > 4 was achieved in 64 plus minus 36 min, with a median ED(50) (50% of maximum response) of 0.24 mg kg(minus sign1). The pH was < 4 for 5.3 plus minus 4.8% of the time after the initial response. Loss of pH control occurred in three patients, two of whom had bacterial sepsis. The incidence of upper gastrointestinal bleeding and metabolic alkalosis was evaluated by comparing the study patients to age- and weight-matched historic controls from our center. Bleeding occurred in 1 of 23 (4%) study patients compared to 7 of 23 (30%) controls (p greater-than-or-equal 0.05). Metabolic alkalosis did not develop in the study patients at 24 or 48 h postoperatively (p greater-than-or-equal 0.05 versus controls). Whole blood cyclosporine levels and hepatocellular enzymes were similar in the two groups. We conclude that continuous intravenous infusion of ranitidine in the postoperative pediatric liver transplant recipient raises intragastric pH, decreases the incidence of upper gastrointestinal hemorrhage and prevents the development of metabolic alkalosis.

The low risk of upper gastrointestinal bleeding in patients dispensed corticosteroids

purpose: To determine the incidence of upper gastrointestinal bleeding in patients treated with corticosteroids. patients and methods: The incidence of upper gastrointestinal tract bleeding was assessed in a cohort of 19,880 patients from the Michigan Medicaid billing database with dermatitis and/ or asthma treated with corticosteroids during 1980 to 1984. The frequency of upper gastrointestinal bleeding was assessed within 60 days after each corticosteroid prescription. results: The incidence of upper gastrointestinal bleeding in patients without a past history of upper gastrointestinal bleeding who were exposed to corticosteroids was only 2.8 cases per 10,000 person-months. The rate of upper gastrointestinal bleeding was notably higher in patients receiving anticoagulants and those with a prior history of upper gastrointestinal bleeding (23.0 and 15.9 cases per 10,000 person-months, respectively). conclusion: Because the incidence of upper gastrointestinal bleeding in ambulatory patients treated with corticosteroids is so low, prophylactic therapy should be restricted to high-risk patients, if it is to be used at all.

Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs

To assess the risk of upper gastrointestinal bleeding associated with the use of individual non-narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAI Ds), a multicentre study of 875 cases of upper gastrointestinal bleeding and 2682 hospital controls was done. With control for confounding factors, the overall odds ratio estimate for aspirin taken at least once during the week before the first symptom was 7·2 (95% confidence interval 5·4-9·6). Non-aspirin NSAIDs associated with upper gastrointestinal bleeding were diclofenac (7·9 [4·3-14·6]), indomethacin (4·9 [2·0-12·2]), naproxen (6·5 [2·2-19·6]), and piroxicam (19·1 [8·2-44·3]). Paracetamol, propyphenazone, and dipyrone did not increase the risk. A previous history of gastrointestinal bleeding or peptic ulcer did not greatly affect odds ratio estimates, which differed according to sex and were higher for younger than for older patients. However, the incidence of upper gastrointestinal bleeding was higher among the elderly.