Monday, July 16, 2012

Patients with cirrhosis at increased risk for peptic ulcer rebleeding

Patients with cirrhosis at increased risk for peptic ulcer rebleeding

Hsu YC. Hepatology. 2012;doi:10.1002/hep.25684.

July 16, 2012
Recurrent peptic ulcer bleeding was more common in patients with cirrhosis than among controls in a recent study.

In a population-based retrospective cohort study, researchers analyzed data from 9,711 Taiwanese patients with cirrhosis and portal hypertension who had been hospitalized for peptic ulcer bleeding (PUB) between January 1997 and December 2006, plus 38,844 matched controls. Incidence rates of ulcer bleeding were determined during the study, and hazard ratios were calculated to establish the risk for rebleeding among cirrhotic patients.

The 10-year cumulative incidence rate for recurrent PUB was 43.7% (95% CI, 41.0%-46.3%) in cirrhotic patients and 31.4% (95% CI, 30.6%-32.2%) in controls (P<.0001). Patients with cirrhosis were more prone to rebleeding than controls across all evaluated time intervals after adjustment for death (14.4% compared with 11.3% for 1 year; 26.1% vs. 22.5% for 5 years, and 28.4% vs. 27.1% for 10 years, P<.001).

Recurrent PUB within 10 years was independently associated with use of antisecretory drugs (HR=3.06; 95% CI, 2.90-3.23), propranolol (HR=0.78; 95% CI, 0.73-0.84) and antisecretory drugs with ulcerogenics (HR=0.81; 95% CI, 0.74-0.90). An independent association was established between peptic ulcer bleeding and cirrhosis (adjusted HR=3.19; 95% CI, 2.62-3.89), but investigators found that this risk diminished as patients aged and the risk for death exceeded the rebleeding risk (adjusted HR=0.98; 95% CI, 0.98-0.98). Risk decreased from 32.9% in patients aged 20 to 39 years to 23.4% in those older than 60 years, compared with an increase from 22.6% to 28.9% in controls from the same age ranges.

“Our findings should inspire further research designed to explore effective therapy to reduce this excessive risk of rebleeding in patients with cirrhosis, particularly for those [younger than] 60 years of age,” the researchers concluded. “The reduced rebleeding risk in relation to propranolol use suggests that nonselective beta-blockers are promising for this indication and warrants validation in clinical trials.”

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