Risk Factors for Development and Recurrence of Peptic Ulcer Disease

Jin Joo Kim; Nayoung Kim; Byoung Hwan Lee; Jung Mook Kang; Pyoungju Seo; Min Kyoung Lim; Jung Hee Kwon; Byeong Jun Song; Jung Won Lee; Sang Hyup Lee; Young Soo Park; Jin-Hyeok Hwang; Jin-Wook Kim; Sook-Hyang Jeong; Dong Ho Lee; Hyun Chae Jung; In Sung Song

doi:10.4166/kjg.2010.56.4.220

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Kim, Kim, Lee, Kang, Seo, Lim, Kwon, Song, Lee, Lee, Park, Hwang, Kim, Jeong, Lee, Jung, and Song: Risk Factors for Development and Recurrence of Peptic Ulcer Disease

Original Article

Korean J Gastroenterol 2010;56(4):220-228.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.4.220

Risk Factors for Development and Recurrence of Peptic Ulcer Disease

Jin Joo Kim, M.D.^∗, Nayoung Kim, M.D.^∗,^†,, Byoung Hwan Lee, M.D.^†, Jung Mook Kang, M.D.^∗, Pyoungju Seo, M.D.^†, Min Kyoung Lim, M.Sc.^‡, Jung Hee Kwon, M.D.^∗, Byeong Jun Song, M.D^∗, Jung Won Lee, M.D.^∗, Sang Hyup Lee, M.D.^∗,^†, Young Soo Park, M.D.^∗,^†, Jin-Hyeok Hwang, M.D.^∗,^†, Jin-Wook Kim, M.D.^∗,^†, Sook-Hyang Jeong, M.D.^∗,^†, Dong Ho Lee, M.D.^∗,^†, Hyun Chae Jung, M.D.^∗, In Sung Song, M.D.^∗

^∗Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea

^†Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

^‡Research and Development Center, Health Insurance Review and Assessment Service, Seoul, Korea

Correspondence to: Nayoung Kim, M.D. Department of Internal Medicine, Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Sungnam 463-707, Korea Tel: +82-31-787-7008, Fax: +82-31-787-4051 E-mail: nayoungkim49@empal.com

Received 27 May 2010 Accepted 2 July 2010

Abstract

Background/Aims

Peptic ulcer disease (PUD) is one of the common gastrointestinal diseases, and its medical management has been developed so much that the incidence of its serious complications, such as bleeding and perforation, are declining significantly. Its prevalence in Korea is not definitely decreased, probably due to increasing proportion of elderly patients and their rising usage of non-steroidal anti-inflammatory drugs (NSAIDs) and aspirins. This study was conducted to identify the risk factors for development and recurrence of peptic ulcer disease in Korea.

Methods

From 2003 to 2008, upper gastrointestinal endoscopy and detailed personal questionnaires were performed for patients who visited Department of Gastroenterology at Seoul National University Bundang Hospital. In total, 475 PUD patients and 335 non-ulcer dyspepsia patients were included. The results of questionnaires and repeated upper gastrointestinal endoscopy at initial diagnosis time and follow-up periods were analyzed.

Results

Multivariable analysis showed that male, H. pylori infection, NSAIDs use and smoking were risk factors for the development of PUD. The use of proton pump inhibitors (PPIs) and H2 receptor antagonists has significantly reduced the risk of PUD in patients who had taken NSAIDs and/or aspirins. H. pylori infection was found as the only risk factor for the recurrence of PUD.

Conclusions

For the old patients who are taking drugs, such as NSAIDs and aspirins, concomitant use of PPIs or H2 receptor antagonists should be considered to protect from the development of PUD. H. pylori eradication has been confirmed again to be essential for the treatment of PUD patients infected with H. pylori.

Keywords: Peptic ulcer, Risk factors, Helicobacter pylori, NSAIDs, PPIs

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Table 1.

Comparisons of the Clinical Characteristics between Patients with Peptic Ulcer Disease and Controls

	Controls (n=335) n (%)	Peptic ulcer disease (n=475) n (%)	p
Age (yr, mean± SD)	52.1±12.4	58.2±14.9	＜0.001
Age over 70	19 (5.6)	106 (29.6)	＜0.001
Male	103 (30.7)	334 (70.3)	＜0.001
Female	232 (69.3)	141 (29.7)
Location of ulcer
Gastric ulcer		266 (56.0)
Duodenal ulcer		209 (44.0)
Current smoking	31 (9.3)	163 (34.3)	＜0.001
Male	25 (24.3)	158 (47.3)	＜0.001
Female	6 (2.6)	5 (3.5)	0.069
Current alcohol drinking	59 (17.6)	170 (35.8)	＜0.001
Male	42 (40.8)	164 (49.1)	＜0.001
Female	17 (7.3)	6 (4.3)	0.095
NSAIDs within 4 weeks	38 (11.3)	112 (23.6)	＜0.001
Aspirins within 4 weeks	36 (10.7)	107 (22.5)	＜0.001
H. pylori infection	200 (59.7)	345 (72.6)	＜0.001

NSAIDs, non-steroidal inflammatory drugs; H. pylori, Helicobacter pylori.

Table 2.

Relationship between Peptic Ulcer Disease and Duration of NSAIDs and Aspirin Medication

		Controls (n=335) n (%)	Peptic ulcer disease (n=475) n (%)	p
NSAIDs	Within 4 weeks	38 (11.3)	112 (23.6)	＜0.001
NSAIDs	From 4 to 8 weeks	36 (10.7)	58 (12.2)	0.507
Aspirins	Within 4 weeks	36 (10.7)	107 (22.5)	＜0.001
Aspirins	From 4 to 8 weeks	11 (3.3)	33 (6.9)	0.023

NSAIDs, non-steroidal anti-inflammatory drugs.

Table 3.

Multivariate Analysis for the Risk Factors of Peptic Ulcer Disease Development

	Controls (n=335) n (%)	Peptic ulcer disease (n=475) n (%)	Odds ratio	95% Confidence interval	p
Male	103 (30.7)	334 (70.3)	7.65	2.97-19.71	＜0.001
H. pylori infection	200 (59.7)	345 (72.6)	5.59	2.35-13.26	＜0.001
NSAIDs within 4 weeks	38 (11.3)	112 (23.6)	3.31	1.12-9.80	0.031
Current smoking	31 (9.3)	163 (34.3)	2.64	1.04-6.68	0.041

H. pylori, Helicobacter pylori; NSAIDs, non-steroidal inflammatory drugs.

Table 4.

Comparisons of the Clinical Characteristics Depending on the Location of Peptic Ulcer Disease

	Gastric ulcer (n=265) n (%)	Duodenal ulcer (n=210) n (%)	p
Age (yr, mean± SD)	61.9±13.7	53.3±15.1	＜0.001
Age over 70	76 (28.6)	30 (14.2)	＜0.001
BMI over 25 kg/m²	30 (11.3)	36 (17.1)	0.038
Blood type	n=154	n=137	0.028
A	51 (33.1)	34 (24.8)
B	40 (30.0)	32 (23.4)
AB	16 (10.4)	15 (10.9)
O	47 (30.5)	56 (40.9)
Monthly income
Below 1,000,000 won	20 (7.5)	11 (5.2)	0.011
Over 8,000,000 won	14 (5.3)	27 (12.9)	0.011
Above college graduation	57 (21.5)	64 (30.5)	0.007
Current smoking	101 (38.1)	62 (29.5)	0.010
H. pylori infection	180 (68.0)	165 (78.6)	0.007
Past history of	16 (6.0)	27 (12.9)	0.007
H. pylori eradication
NSAIDs within 4 weeks	69 (26.0)	43 (20.5)	0.168
Aspirin within 4 weeks	66 (24.9)	41 (19.5)	0.175

BMI, Body mass index; H. pylori, Helicobacter pylori; NSAIDs, non-steroidal inflammatory drugs.

Table 5.

Peptic Ulcer Disease Development Depending on the Use of NSAIDs and Gastroprotective Agents

				Control (n=335) n (%)	Peptic ulcer disease (n=475) n (%)	p
PPIs within 4 weeks	(＋)	NSAIDs within 4 weeks	(＋)	4 (6.9)	54 (93.1)	0.334
	(＋)	NSAIDs within 4 weeks	(−)	18 (10.1)	161 (89.9)	0.334
	(−)	NSAIDs within 4 weeks	(＋)	34 (36.6)	59 (63.4)	＜0.001
	(−)	NSAIDs within 4 weeks	(−)	277 (58.7)	196 (41.4)	＜0.001
H₂ receptor antagonists within 4 weeks	(＋)	NSAIDs within 4 weeks	(＋)	14 (23.0)	47 (77.0)	0.097
	(＋)	NSAIDs within 4 weeks	(−)	49 (33.1)	99 (66.9)	0.097
	(−)	NSAIDs within 4 weeks	(＋)	24 (26.7)	66 (73.3)	＜0.001
	(−)	NSAIDs within 4 weeks	(−)	246 (48.8)	258 (51.2)	＜0.001

PPIs, proton pump inhibitors; NSAIDs, non-steroidal inflammatory drugs.

Table 6.

Comparisons of Characteristics Depending on the Recurrence of Peptic Ulcer Disease

	Recurrence^∗ (n=37) n (%)	No recurrence (n=207) n (%)	p
Age over 70	14 (37.8)	34 (16.4)	0.005
Location of ulcer
Gastric ulcer	20 (54.1)	115 (55.6)	0.921
Duodenal ulcer	17 (45.9)	92 (44.4)
Current smoking	11 (29.8)	69 (33.3)	0.821
Current alcohol drinking	12 (32.4)	69 (33.3)	0.825
H. pylori infection	19 (51.4)	168 (81.2)	＜0.001
H. pylori eradication	10 (27.0)	142 (68.6)	＜0.001
Number of H. pylori eradication trial			0.851
1 ^st	8 (21.6)	120 (58.0)
2 ^nd	1 (2.7)	14 (6.8)
3 ^rd	1 (2.7)	8 (3.9)
Chronic illness^†	20 (54.1)	65 (31.4)	0.034
Aspirins within 4 weeks	20 (54.1)	46 (22.2)	＜0.001
NSAIDs within 4 weeks	9 (24.3)	48 (23.2)	0.951
Time to recurrence
≤1 year	17 (45.9)
1-2 year	10 (27.1)
2-3 year	6 (16.2)
3-4 year	4 (10.8)

H. pylori, Helicobacter pylori; NSAIDs, non-steroidal inflammatory drugs.

^∗ Recurrence was analyzed among 246 peptic ulcer patients who had showed scar in the follow-up endoscopy after ulcer medication.

^† Chronic illness includes diabetes mellitus, hypertension, hypercholesterolemia, ischemic heart disease, congestive heart failure, cerebrovascular attack, chronic hepatitis, liver cirrho-sis, inflammatory bowel disease, rheumatic arthritis, and chronic renal disease.

Table 7.

Multivariate Analysis for the Risk Factors of Peptic Ulcer Disease Recurrence

	Recurrence (n=37) n (%)	No recurrence (n=207) n (%)	Odds ratio	95% Confidence interval	p
Age over 70	14 (37.8)	34 (16.4)	0.334	0.065-1.723	0.190
H. pylori infection	19 (51.4)	168 (81.2)			1.000
H. pylori eradication	10 (27.0)	142 (68.6)	0.024	0.003-0.175	0.000
Chronic illness	20 (54.1)	65 (31.4)	0.642	0.133-3.112	0.582
Aspirins within 4 weeks	20 (54.1)	46 (22.2)	2.752	0.490-15.441	0.250

H. pylori, Helicobacter pylori; NSAIDs, non-steroidal inflammatory drugs.

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