Short-term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population-based case-crossover study

Aliment Pharmacol Ther. 2015 Sep;42(5):599-606. doi: 10.1111/apt.13298. Epub 2015 Jun 22.


Background: Controversy exists regarding glucocorticoids therapy and the risk of peptic ulcer bleeding (PUB).

Aim: The present study was undertaken to determine whether short-term use of glucocorticoids is associated with the occurrence of peptic ulcer bleeding.

Methods: The records of adult patients hospitalised for newly diagnosed peptic ulcer bleeding from 2000 to 2012 were retrieved from the Taiwan National Health Insurance Research Database, a nationwide population-based registry system. The association between systemic glucocorticoids usage and peptic ulcer bleeding was determined with a conditional logistic regression model comparing cases and controls during time windows of 7, 14 and 28 days using a case-crossover design.

Results: Of the 8894 enrolled patients, the adjusted self-matched odds ratios for peptic ulcer bleeding after exposure to the glucocorticoids were 1.37 (95% CI: 1.12-1.68, P = 0.003) for the 7-day window, 1.66 (95% CI: 1.38-2.00, P < 0.001) for the 14-day window and 1.84 (95% CI: 1.57-2.16, P < 0.001) for the 28-day window. Moderate to high, but not low dose glucocorticoids (methylprednisolone <4 mg/day or its equivalence) were associated with an increased risk of peptic ulcer bleeding. Concomitant use of a nonselective nonsteroidal anti-inflammatory drug (NSAID) or aspirin further elevated the risk. However, it does not eliminate the effect of underlying diseases flare-up that may have placed the patients at risk for peptic ulcer bleeding in this kind of study design.

Conclusions: Short-term (7-28 days) exposure to glucocorticoids is significantly associated with peptic ulcer bleeding; this risk seems dose-dependent and is higher when nonselective NSAIDs or aspirin are used concurrently.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Aspirin / administration & dosage
  • Aspirin / adverse effects
  • Case-Control Studies
  • Cross-Over Studies
  • Databases, Factual
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Drug Combinations
  • Female
  • Glucocorticoids / adverse effects*
  • Hospitalization
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Peptic Ulcer Hemorrhage / chemically induced*
  • Peptic Ulcer Hemorrhage / epidemiology
  • Research Design
  • Taiwan / epidemiology
  • Time Factors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Drug Combinations
  • Glucocorticoids
  • Aspirin