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Co-Morbidities Affect Risk of Non-Variceal Upper Gastrointestinal Bleeding.
Gastroenterology. 2013 Mar 4;
Authors: Crooks CJ, West J, Card TR
Abstract
BACKGROUND AND AIMS: The incidence of upper gastrointestinal bleeding (GIB) has not been reduced, despite the decreasing incidence of peptic ulcer, strategies to eradicate against Helicobacter pylori infection, and prophylaxis against ulceration from non-steroidal anti-inflammatory drugs (NSAIDs). Other factors might therefore be involved in the pathogenesis of GIB. Patients with GIB have increasing non-gastrointestinal co-morbidity, so we investigated whether co-morbidity itself increased the risk of GIB. METHODS: We conducted a matched case control study using linked primary and secondary care data collected in England from 1st April 1997 through 31st August 2010. Patients older than 15 years with non-variceal GIB (n=16,355) were matched to 5 controls by age, sex, year & practice (n=81,636). All available risk factors for GIB were extracted and modelled using conditional logistic regression. Adjusted associations with non gastrointestinal co-morbidity, defined using the Charlson index, were then tested and sequential population attributable fractions (PAF) calculated. RESULTS: Co-morbidity had a strong graded association with GIB; the adjusted OR for a single co-morbidity was 1.43 (95% confidence interval [CI], 1.35-1.52) and for multiple or severe co-morbidity was 2.26 (95% CI, 2.14%-2.38%). The additional PAF for co-morbidity (19.8%; 95% CI, 18.4%-21.2%) was considerably larger than that for any other measured risk factor, including aspirin or NSAID use (3.0% and 3.1% respectively). CONCLUSIONS: Non-gastrointestinal co-morbidity is an independent risk factor for GIB, and contributes to a greater proportion of patients with bleeding in the population than other recognised risk factors. These findings could help in the assessment of potential causes of GIB, and also explain why the incidence of GIB remains high in an ageing population.
PMID: 23470619 [PubMed - as supplied by publisher]