Tomizawa Minoru, Shinozaki Fuminobu, Hasegawa Rumiko, Shirai Yoshinori, Motoyoshi Yasufumi, Sugiyama Takao, Yamamoto Shigenori, Ishige Naoki
Department of Gastroenterology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan.
Department of Radiology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba 284-0003, Japan.
Exp Ther Med. 2017 May;13(5):1927-1931. doi: 10.3892/etm.2017.4214. Epub 2017 Mar 9.
Peptic ulcer bleeding can be fatal. Non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids and immunosuppressive agents are administered for long-term usage. The present study assessed the association between peptic ulcer bleeding and administration of NSAIDs, corticosteroids and immunosuppressive agents. Furthermore, the efficacy of lowering the risk of peptic ulcer bleeding with proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) was evaluated. Medical records were retrospectively analyzed for patients subjected to an upper gastrointestinal (GI) endoscopy performed at the National Hospital Organization Shimoshizu Hospital (Yotsukaido, Japan) from October 2014 to September 2015. During this period, a total of 1,023 patients underwent an upper GI endoscopy. A total of 1,023 patients, including 431 males (age, 68.1±12.9 years) and 592 females (age, 66.4±12.3 years), who had been administered NSAIDs, corticosteroids, immunosuppressive agents, PPIs and H2RAs, were respectively enrolled. Endoscopic findings of the patients were reviewed and their data were statistically analyzed. Logistic regression analysis was used to determine the odds ratio of peptic ulcer bleeding for each medication; immunosuppressive agents had an odds ratio of 5.83, which was larger than that for NSAIDs (4.77). The Wald test was applied to confirm the correlation between immunosuppressive agents and peptic ulcer bleeding. Furthermore, χ tests were applied to the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. Immunosuppressive agents had the largest χ, and the P-value was 0.03. Administration of PPIs was significantly correlated with non-peptic ulcer bleeding (P=0.02); furthermore, a tendency toward non-peptic ulcer bleeding with administration of H2RA was indicated, but it was not statistically significant (P=0.12). In conclusion, immunosuppressive agents were correlated with peptic ulcer bleeding and PPIs were effective at lowering the risk of peptic ulcer bleeding.
消化性溃疡出血可能是致命的。非甾体抗炎药（NSAIDs）、皮质类固醇和免疫抑制剂长期使用。本研究评估了消化性溃疡出血与NSAIDs、皮质类固醇和免疫抑制剂使用之间的关联。此外，还评估了质子泵抑制剂（PPI）和组胺2受体拮抗剂（H2RA）降低消化性溃疡出血风险的疗效。对2014年10月至2015年9月在日本八千代市国立医院组织下进行上消化道（GI）内镜检查的患者的病历进行回顾性分析。在此期间，共有1023例患者接受了上消化道内镜检查。共有1023例患者，包括431例男性（年龄68.1±12.9岁）和592例女性（年龄66.4±12.3岁），分别使用了NSAIDs、皮质类固醇、免疫抑制剂、PPI和H2RA。对患者的内镜检查结果进行了回顾，并对其数据进行了统计分析。采用逻辑回归分析确定每种药物导致消化性溃疡出血的比值比；免疫抑制剂的比值比为5.83，高于NSAIDs（4.77）。采用Wald检验来确认免疫抑制剂与消化性溃疡出血之间的相关性。此外，对消化性溃疡出血与PPI或H2RA使用之间的相关性进行χ检验。免疫抑制剂的χ值最大，P值为0.03。PPI的使用与非消化性溃疡出血显著相关（P=0.02）；此外，H2RA的使用显示出非消化性溃疡出血的趋势，但无统计学意义（P=0.12）。总之，免疫抑制剂与消化性溃疡出血相关，PPI可有效降低消化性溃疡出血的风险。
