Acute upper gastrointestinal bleeding: Comparison between Recent users and nonusers of nonsteroidal anti-inflammatory drugs

Background and Study Aims: To determine clinical, endoscopic, and outcome differences between recent users and nonusers of nonsteroidal anti-inflammatory drugs (NSAIDs) presenting with upper gastrointestinal bleeding (UGIB). Patients and Methods: A total of 330 consecutive patients who presented with clinical manifestations of UGIB underwent urgent endoscopy after clinical assessment within 12 h of admission. The patients were divided into two groups, depending on whether there was a positive or negative history of recent NSAID use. Urgent endoscopy followed by endoscopic hemostasis and/ or biopsy, as needed, was performed by the same endoscopist, who was blinded to the patients' clinical status. Results: The baseline characteristics, clinically estimated severity of UGIB, and outcome did not differ between the two groups. Recent NSAID users were found to bleed from an ulcer more frequently (P= 0.009) than nonusers of NSAIDs, the latter more often having a history of peptic ulcer or UGIB (P= 0.02). Bleeding ulcers were mostly duodenal in the NSAID group and gastric in the non-NSAID group (P<0.001). Helicobacter pylori infection was significantly more common among NSAID users (P<0.01). The group of NSAID users included a significantly greater proportion of alcohol abusers (P= 0.01), who were found to bleed mostly from erosive gastritis. Conclusions: Recent NSAID users were found to bleed from ulcers, mostly duodenal, and to have H. pylori infection more frequently than UGI bleeders with a negative history of NSAID consumption. Alcohol abuse was also more common among NSAID users. The severity of bleeding and the outcome did not differ between the two groups.