Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study

doi:10.1016/S0002-9343(01)00941-X

The American Journal of Medicine

Volume 111, Issue 7, November 2001, Pages 541-545

https://doi.org/10.1016/S0002-9343(01)00941-X Get rights and content

Abstract

Purpose

We assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding.

Subjects and methods

We conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal anti-inflammatory drugs, aspirin, and anticoagulants during 1991 to 1995 were obtained from a countywide prescription database. All hospitalizations because of upper gastrointestinal bleeding were identified through the Hospital Discharge Registry. The observed numbers of patients with gastrointestinal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population who did not receive prescriptions for any of the drugs under study.

Results

A total of 45,980 patients accrued 18,379 person-years of corticosteroid use. There were 109 hospital admissions for gastrointestinal bleeding among corticosteroid users, compared with 26 expected, yielding a relative risk of 4.2 [95% confidence interval (CI): 3.4 to 5.0]. Among corticosteroid users who did not use other drugs associated with gastrointestinal bleeding, the relative risk was 2.9 (95% CI: 2.2 to 3.7). The relative risk decreased further to 1.9 (95% CI: 1.4 to 2.5) when current corticosteroid usage was compared with former usage.

Conclusion

We observed an increased risk of hospitalization because of upper gastrointestinal bleeding among patients prescribed corticosteroids, especially among those who use other medications. Confounding from the underlying disease may also have contributed to the observed increase in risk.

Section snippets

Material and methods

The study was conducted in North Jutland County, Denmark, which had about 490,000 inhabitants during 1991 to 1995. The National Health Service refunded 75% of the cost of prescribed corticosteroids; nontopical corticosteroids were available by prescription only. The Pharmaco-Epidemiologic Prescription Database of North Jutland was initiated in January 1991 (13). It includes the patient’s personal identification number, type of drug prescribed (14), date of prescription, date of dispensing of

Results

A total of 45,980 persons (20,609 men and 25,371 women) were prescribed corticosteroids at least once during the study period, accruing 18,379 person-years of current use and 101,807 person-years of former use of corticosteroids. For current use, 14,897 person-years (81%) involved use of corticosteroids without other study drugs. The remaining person-years included various combinations of use of other drugs associated with gastrointestinal bleeding. The median age when corticosteroids were

Discussion

We found about a threefold increased risk of hospitalization because of upper gastrointestinal bleeding associated with periods of use of corticosteroids. The risk was especially great when corticosteroid treatment was combined with the use of aspirin and other NSAIDs. When periods of current use of corticosteroids were compared with periods of former use, the relative risk was about 2, suggesting that confounding, probably by indication for corticosteroids use or by severity of underlying

Acknowledgements

We thank the staff at the Department of Health Insurance and Hospital Discharge Registries in the County of North Jutland (Sygesikringen, Nordjyllands amt) for assistance in preparing the data for analysis.

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Clinical studyRisk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study

Abstract

Purpose

Subjects and methods

Results

Conclusion

Section snippets

Material and methods

Results

Discussion

Acknowledgements

Am J Med

Am J Gastroenterol

Lancet

Chronic stress and peptic ulcer. Effect of corticotropin (ATCH) and cortisone on gastric secretion

JAMA

Histopathology of steroid-induced ulcers

Arch Pathol

Clinical and physiological implications of the steroid-induced peptic ulcer

N Engl J Med

Corticosteroid use and peptic ulcer diseaserole of nonsteroidal anti-inflammatory drugs

Ann Intern Med

Nonassociation of adrenocorticosteroid therapy and peptic ulcer

N Engl J Med

Association of adrenocorticosteroid therapy and peptic-ulcer disease

N Engl J Med

Is the steroid ulcer a myth?

N Engl J Med

Clinical study
Risk of hospitalization resulting from upper gastrointestinal bleeding among patients taking corticosteroids: a register-based cohort study