Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding
Background & Aims The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors mig...
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| Format: | Article |
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WB Saunders
2013
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| Online Access: | https://eprints.nottingham.ac.uk/2461/ |
| _version_ | 1848790791204372480 |
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| author | Crooks, Colin John West, Joe Card, Timothy R. |
| author_facet | Crooks, Colin John West, Joe Card, Timothy R. |
| author_sort | Crooks, Colin John |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background & Aims
The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors might therefore be involved in the pathogenesis of GIB. Patients with GIB have increasing nongastrointestinal comorbidity, so we investigated whether comorbidity itself increased the risk of GIB.
Methods
We conducted a matched case-control study using linked primary and secondary care data collected in England from April 1, 1997 through August 31, 2010. Patients older than 15 years with nonvariceal GIB (n = 16,355) were matched to 5 controls by age, sex, year, and practice (n = 81,636). All available risk factors for GIB were extracted and modeled using conditional logistic regression. Adjusted associations with nongastrointestinal comorbidity, defined using the Charlson Index, were then tested and sequential population attributable fractions calculated.
Results
Comorbidity had a strong graded association with GIB; the adjusted odds ratio for a single comorbidity was 1.43 (95% confidence interval [CI]: 1.35–1.52) and for multiple or severe comorbidity was 2.26 (95% CI: 2.14%–2.38%). The additional population attributable fraction for comorbidity (19.8%; 95% CI: 18.4%–21.2%) was considerably larger than that for any other measured risk factor, including aspirin or nonsteroidal anti-inflammatory drug use (3.0% and 3.1%, respectively).
Conclusions
Nongastrointestinal comorbidity is an independent risk factor for GIB, and contributes to a greater proportion of patients with bleeding in the population than other recognized risk factors. These findings could help in the assessment of potential causes of GIB, and also explain why the incidence of GIB remains high in an aging population. |
| first_indexed | 2025-11-14T18:18:13Z |
| format | Article |
| id | nottingham-2461 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:18:13Z |
| publishDate | 2013 |
| publisher | WB Saunders |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-24612020-05-04T20:19:11Z https://eprints.nottingham.ac.uk/2461/ Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding Crooks, Colin John West, Joe Card, Timothy R. Background & Aims The incidence of upper gastrointestinal bleeding (GIB) has not been reduced despite the decreasing incidence of peptic ulcers, strategies to eradicate Helicobacter pylori infection, and prophylaxis against ulceration from nonsteroidal anti-inflammatory drugs. Other factors might therefore be involved in the pathogenesis of GIB. Patients with GIB have increasing nongastrointestinal comorbidity, so we investigated whether comorbidity itself increased the risk of GIB. Methods We conducted a matched case-control study using linked primary and secondary care data collected in England from April 1, 1997 through August 31, 2010. Patients older than 15 years with nonvariceal GIB (n = 16,355) were matched to 5 controls by age, sex, year, and practice (n = 81,636). All available risk factors for GIB were extracted and modeled using conditional logistic regression. Adjusted associations with nongastrointestinal comorbidity, defined using the Charlson Index, were then tested and sequential population attributable fractions calculated. Results Comorbidity had a strong graded association with GIB; the adjusted odds ratio for a single comorbidity was 1.43 (95% confidence interval [CI]: 1.35–1.52) and for multiple or severe comorbidity was 2.26 (95% CI: 2.14%–2.38%). The additional population attributable fraction for comorbidity (19.8%; 95% CI: 18.4%–21.2%) was considerably larger than that for any other measured risk factor, including aspirin or nonsteroidal anti-inflammatory drug use (3.0% and 3.1%, respectively). Conclusions Nongastrointestinal comorbidity is an independent risk factor for GIB, and contributes to a greater proportion of patients with bleeding in the population than other recognized risk factors. These findings could help in the assessment of potential causes of GIB, and also explain why the incidence of GIB remains high in an aging population. WB Saunders 2013-06 Article PeerReviewed Crooks, Colin John, West, Joe and Card, Timothy R. (2013) Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding. Gastroenterology, 144 (7). 1384-1393.e2. ISSN 0016-5085 Etiology; Gastrointestinal Bleeding; Stomach http://www.sciencedirect.com/science/article/pii/S0016508513002898 doi:10.1053/j.gastro.2013.02.040 doi:10.1053/j.gastro.2013.02.040 |
| spellingShingle | Etiology; Gastrointestinal Bleeding; Stomach Crooks, Colin John West, Joe Card, Timothy R. Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title | Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title_full | Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title_fullStr | Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title_full_unstemmed | Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title_short | Comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| title_sort | comorbidities affect risk of nonvariceal upper gastrointestinal bleeding |
| topic | Etiology; Gastrointestinal Bleeding; Stomach |
| url | https://eprints.nottingham.ac.uk/2461/ https://eprints.nottingham.ac.uk/2461/ https://eprints.nottingham.ac.uk/2461/ |