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Proton pump inhibitors reduce the long‐term risk of recurrent upper gastrointestinal bleeding: an observational study
Author(s) -
MASSÓ GONZÁLEZ E. L.,
GARCÍA RODRÍGUEZ L. A.
Publication year - 2008
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2008.03780.x
Subject(s) - medicine , upper gastrointestinal bleeding , aspirin , warfarin , confidence interval , relative risk , proton pump inhibitor , nonsteroidal , gastroenterology , observational study , surgery , endoscopy , atrial fibrillation
Summary 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.