Dw. Kaufman et al., The risk of acute major upper gastrointestinal bleeding among users of aspirin and ibuprofen at various levels of alcohol consumption, AM J GASTRO, 94(11), 1999, pp. 3189-3196
OBJECTIVE: Major upper gastrointestinal bleeding (UGIB) is the most importa
nt adverse effect of aspirin and other nonsteroidal anti-inflammatory drugs
(NSAIDs). Alcoholic beverages also precipitate UGIB. This analysis was con
ducted to evaluate whether the deleterious effects of NSAIDs are further in
creased among drinkers.
METHODS: An interview-based, case-control study was conducted in the U.S. a
nd Sweden; 1224 patients hospitalized with acute major UGIB due to newly oc
curring peptic ulcer or gastritis were compared to 2945 neighbor controls.
RESULTS: Compared with those who drank less than one drink/wk, the relative
risk of acute UGIB increased with increasing alcohol consumption, rising t
o 2.8 among those who drank greater than or equal to 21 drinks/wk. Among cu
rrent drinkers, the relative risk of acute UGIB due to the use of aspirin w
as raised at all levels of alcohol consumption; the estimate for aspirin ta
ken at least every other day (regular use) at doses of >325 mg among all cu
rrent drinkers combined was 7.0; for regular use at lower doses, the corres
ponding estimate was 2.8, and for any occasional use, it was 2.4. All estim
ates were statistically significant. Data for ibuprofen were more limited,
but the relative risk estimates did not appear to vary consistently with le
vel of alcohol consumption. For regular use tall doses combined), the estim
ate among all drinkers combined was significantly elevated, at 2.7; occasio
nal ibuprofen use was not associated with UGIB (1.2). There were insufficie
nt data to evaluate other NSAIDs according to alcohol consumption.
CONCLUSIONS: The findings suggest that acute UGIB is similarly associated w
ith the use of the two most common nonprescription NSAIDs, aspirin and ibup
rofen, at all levels of alcohol consumption. As heavy alcohol intake indepe
ndently increases the risk, the incidence of UGIB is highest among persons
who are both heavy drinkers and users of aspirin or ibuprofen. (C) 1999 by
Am. Coil. of Gastroenterology.