Risk factors associated with uncomplicated peptic ulcer and changes in medication use after diagnosis

PLoS One. 2014 Jul 8;9(7):e101768. doi: 10.1371/journal.pone.0101768. eCollection 2014.

Abstract

Background: Few epidemiologic studies have investigated predictors of uncomplicated peptic ulcer disease (PUD) separately from predictors of complicated PUD.

Objective: To analyze risk factors associated with uncomplicated PUD and medication use after diagnosis.

Methods: Patients diagnosed with uncomplicated PUD (n = 3,914) were identified from The Health Improvement Network database among individuals aged 40-84 years during 1997-2005, with no previous history of PUD. Prescription records for the year after the date of diagnosis were reviewed and a nested case-control analysis was performed to calculate the odds ratios for the association of potential risk factors with PUD.

Results: Medications associated with developing uncomplicated PUD included current use of acetylsalicylic acid (ASA), nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol, selective serotonin reuptake inhibitors, antidepressants, antihypertensives or acid suppressants. Uncomplicated PUD was significantly associated with being a current or former smoker and having had a score of at least 3 on the Townsend deprivation index. Approximately 50% of patients who were users of ASA (19% of patients) or chronic users of NSAIDs (7% of patients) at diagnosis did not receive another prescription of the medication in the 60 days after diagnosis, and 30% were not represcribed therapy within a year. Among patients who were current users of ASA or chronic NSAIDs at the time of the PUD diagnosis and received a subsequent prescription for their ASA or NSAID during the following year, the vast majority (80-90%) also received a proton pump inhibitor coprescription.

Conclusions: Our results indicate that several risk factors for upper gastrointestinal bleeding are also predictors of uncomplicated PUD, and that some patients do not restart therapy with ASA or NSAIDs after a diagnosis of uncomplicated PUD. Further investigation is needed regarding the consequences for these patients in terms of increased cardiovascular burden due to discontinuation of antiplatelet therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Aspirin / administration & dosage
  • Aspirin / adverse effects
  • Case-Control Studies
  • Comorbidity
  • Female
  • Helicobacter Infections / complications
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / diagnosis
  • Peptic Ulcer / epidemiology*
  • Peptic Ulcer / etiology*
  • Proton Pump Inhibitors / administration & dosage
  • Proton Pump Inhibitors / adverse effects
  • Risk Factors
  • United Kingdom / epidemiology

Substances

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

Grants and funding

The study was funded by AstraZeneca R&D, Mölndal, Sweden. Two of the manuscript authors, Saga Johansson and Péter Nagy, are employees of AstraZeneca. Saga Johansson and Péter Nagy provided input on the design of the study, were involved in analysis and interpretation of the data and contributed fully to the development and finalization of the manuscript, and approved it for submission. Other employees of AstraZeneca were given the opportunity to comment on manuscript drafts and the authors gave consideration to any relevant comments received.