A Prospective Study of Alcohol Consumption and Smoking and the Risk of Major Gastrointestinal Bleeding in Men

PLoS One. 2016 Nov 8;11(11):e0165278. doi: 10.1371/journal.pone.0165278. eCollection 2016.

Abstract

Background and aims: Data regarding smoking and alcohol consumption and risk of gastrointestinal bleeding (GIB) are sparse and conflicting. We assessed the risk of major GIB associated with smoking and alcohol consumption in a large, prospective cohort.

Methods: We prospectively studied 48,000 men in the Health Professional follow-up Study (HPFS) who were aged 40-75 years at baseline in 1986. We identified men with major GIB requiring hospitalization and/or blood transfusion via biennial questionnaires and chart review.

Results: We documented 305 episodes of major GIB during 26 years of follow-up. Men who consumed >30 g/day of alcohol had a multivariable relative risk (RR) of 1.43 (95% confidence interval (CI), 0.88-2.35; P for trend 0.006) for major GIB when compared with nondrinkers. Alcohol consumption appeared to be primarily related to upper GIB (multivariable RR for >30 g/day vs. nondrinkers was 1.35; 95% CI, 0.66-2.77; P for trend 0.02). Men who consumed ≥ 5 drinks/week vs. < 1 drink/month of liquor had a multivariable RR of 1.72 (95% CI, 1.26-2.35, P for trend <0.001). Wine and beer were not significantly associated with major GIB. The risk of GIB associated with NSAIDs/aspirin use increased with greater alcohol consumption (multivariable RR 1.37; 95% CI, 0.85-2.19 for 1-14g/day of alcohol, RR 1.75; 95% CI, 1.07-2.88 for ≥ 15g/day compared to nondrinkers). Smoking was not significantly associated with GIB.

Conclusions: Alcohol consumption, but not smoking, was associated with an increased risk of major GIB. Associations were most notable for upper GIB associated with liquor intake. Alcohol appeared to potentiate the risk of NSAID-associated GIB.

MeSH terms

  • Alcohol Drinking / adverse effects*
  • Alcoholic Beverages / adverse effects*
  • Aspirin / adverse effects
  • Beer / adverse effects
  • Ethanol / adverse effects*
  • Follow-Up Studies
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Smoking / adverse effects*
  • Surveys and Questionnaires
  • Wine / adverse effects

Substances

  • Ethanol
  • Aspirin

Grant support

The work was supported by the following: National Institutes of Health, National Cancer Institute UM1 CA167552; National Institutes of Health, National Institute for Diabetes and Digestive and Kidney Diseases R01 DK095964 ATC; and National Institutes of Health, National Institute for Diabetes and Digestive and Kidney Diseases K24 DK098311 ATC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.