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The Use of Higher Dose Steroids Increases the Risk of Rebleeding After Endoscopic Hemostasis for Peptic Ulcer Bleeding

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Abstract

Background

Previous studies have shown that several factors such as hemodynamic instability at admission are risk factors for rebleeding of peptic ulcer bleeding. However, whether steroid use increases the risk of rebleeding remains elusive.

Aims

This study aimed to clarify the risk factors for rebleeding after endoscopic hemostasis for peptic ulcer bleeding.

Methods

A total of 185 patients who underwent endoscopic hemostasis for peptic ulcer bleeding at our institution between 2005 and 2017 were retrospectively analyzed. We evaluated factors, including comorbid conditions, in-hospital onset, and steroid use, associated with rebleeding by logistic regression analysis. In addition, we investigated the association between the dose of steroids and rebleeding.

Results

The rebleeding rate after endoscopic hemostasis for peptic ulcer bleeding was 14.6%. In the multivariate analysis, the independent risk factors for rebleeding were steroid use (odds ratio 4.56, p = 0.015), multiple ulcers (4.43, p = 0.005), number of comorbidities ≥ 3 3.18, p = 0.026), hemodynamic instability (3.06, p = 0.039), and number of comorbidities ≥ 3 (2.93, p = 0.047). Furthermore, the use of higher dose steroids (≥ 20 mg per day in prednisolone; 10.55, p = 0.002), but not lower dose (< 20 mg per day in prednisolone), was an independent risk factor for rebleeding in the multivariate analysis. The relationship between steroid use and rebleeding was observed in a dose-dependent manner (p for trend = 0.002).

Conclusions

This study first revealed that using higher dose steroids was an independent risk factor for rebleeding after endoscopic hemostasis for peptic ulcer bleeding, with a dose-response relation.

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Abbreviations

PUB:

Peptic ulcer bleeding

NSAIDs:

Nonsteroid antiinflammatory drugs

GI:

Gastrointestinal

PPI:

Proton pump inhibitor

ASA:

American Society of Anesthesiologists

PSL:

Prednisolone

IQR:

Interquartile range

ORs:

Odds ratios

PEG:

Percutaneous endoscopic gastrostomy

ENBD:

Endoscopic naso-biliary drainage

CI:

Confidence interval

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Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Yutaka Kondo, Waku Hatta, Tomoyuki Koike, Yasushi Takahashi, Masahiro Saito, Takeshi Kanno, Kiyotaka Asanuma, Naoki Asano, Akira Imatani & Atsushi Masamune

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  1. Yutaka Kondo
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  2. Waku Hatta
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  3. Tomoyuki Koike
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  4. Yasushi Takahashi
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  5. Masahiro Saito
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Correspondence to Waku Hatta.

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Kondo, Y., Hatta, W., Koike, T. et al. The Use of Higher Dose Steroids Increases the Risk of Rebleeding After Endoscopic Hemostasis for Peptic Ulcer Bleeding. Dig Dis Sci 63, 3033–3040 (2018). https://doi.org/10.1007/s10620-018-5209-y

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  • DOI: https://doi.org/10.1007/s10620-018-5209-y

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