Proton pump inhibitors reduce the long-term risk of recurrent upper gastrointestinal bleeding: an observational study

Aliment Pharmacol Ther. 2008 Sep 1;28(5):629-37. doi: 10.1111/j.1365-2036.2008.03780.x. Epub 2008 Jun 26.


Background: Between 3% and 40% of patients surviving an episode of upper gastrointestinal bleeding (UGIB) experience a recurrence within 1 year. Aim To characterize further the recurrence rate of UGIB and to investigate the role of long-term acid suppressive therapy in its secondary prevention.

Methods: Recurrent cases of UGIB were identified among patients registered in The Health Improvement Network in the UK. A nested case-control analysis provided relative risk (RR) estimates of factors associated with recurrence.

Results: Of 1287 patients included, 67 (5.2%) were identified with a recurrent UGIB episode, corresponding to a recurrence rate of 17.5 per 1000 person-years during a mean follow-up of 3 years. The greatest risk of recurrence was in patients prescribed the oral anticoagulant warfarin (RR: 5.38; 95% confidence interval: 2.02-14.36). Use of a single proton pump inhibitor (PPIs) was associated with a reduced risk of recurrence (RR: 0.51; 95% confidence interval: 0.26-0.99), even in patients taking warfarin, while current use of H(2)-receptor antagonists was not. After the first episode of UGIB, use of nonsteroidal anti-inflammatory drugs and aspirin was greatly reduced, preventing estimation of the risk associated with these drugs.

Conclusion: Long-term PPI therapy reduces the risk of UGIB recurrence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Ulcer Agents / therapeutic use*
  • Aspirin / adverse effects
  • Case-Control Studies
  • Duodenal Ulcer / chemically induced
  • Duodenal Ulcer / prevention & control*
  • Female
  • Gastrointestinal Hemorrhage / chemically induced
  • Gastrointestinal Hemorrhage / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Proton Pump Inhibitors / therapeutic use*
  • Risk Factors
  • Secondary Prevention
  • Stomach Ulcer / chemically induced
  • Stomach Ulcer / prevention & control*
  • Treatment Outcome
  • Warfarin / adverse effects


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Proton Pump Inhibitors
  • Warfarin
  • Aspirin