بررسي عوامل خطرساز خون ريزي از زخم هاي پپتيك

Risk factots fot eppet gastrointestinal bleeding in patients with peptic ulcer disease : A case-conttol study

Background and purpose : The objective of this study was to evaluate the role of several risk factors in upper gastrointestinal bleeding (UGIB) from peptic ulcers. Materials and methods : Patients with acute UGIB due to peptic ulcers and control patients with peptic ulcer disease without bleeding were enrolled. Upper GI endoscopy and rapid urease test for evaluation of Helicobacter pylori infection were performed in both groups. The relation of the following variables with the risk of UGIB were assessed: sex, age, smoking, previous history of bleeding, non-steroidal anti-inflammatory drugs (NSAID) use, ulcer size, ulcer location, duration of acid-peptic disease and Helicobacter pylori status. Multivariate logistic regression analysis was performed to identify independent risk factors. Results : A total of 161 cases of UGIB and 287 patients with non-bleeding peptic ulcer were enrolled in the study. Univariate analysis showed that smoking and duration of acid-peptic disease were not different in the case and control groups. The odds for the following factors were resulted in the logistic regression analysis: gastric ulcer / duodenal ulcer 11.90 (95% CI: 4.04-35.03), previous GI bleeding 7.72 (95% CI: 4.39-13.58), ulcer size 2.63 (95% CI: 1.20-5.77), NsAID-use 2.21 (95% CI: 1.17-4.20), male sex 1.71 (95% CI: 1.01-2.89) and age by increasing the risk as 1.03 for every year increase in age (95% CI: 1.01-1.04). H. pylori was not an independent factor in the multivariate analysis (OR=0.49, 95% CI: 0.23-1.04). Conclusion : The risk of UGIB is strongly related to gastric ulcer, previous history of bleeding, ulcer size, and NSAID use. In an area with high prevalence of H. pylon infection, this infection may not be a risk factor for bleeding from peptic ulcers.