Peptic Ulcers - Risk Factors

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Highlights	Risk Factors	Lifestyle Changes
Introduction	Diagnosis	Resources
Causes	Treatment	References
Symptoms	Medications	References
Complications	Surgery

Experts do not know of any single factor or group of factors that can determine which infected patients are most likely to develop ulcers.

Risk Factors for NSAID-Induced Ulcers

Between 15 - 25% of patients who have taken NSAIDs regularly will have evidence of one or more ulcers, but in most cases these ulcers are very small. Given the widespread use of NSAIDs, however, the potential number of people who can develop serious problems may be very large. Long-term NSAID use can damage the stomach and, possibly, the small intestine.

The FDA has asked manufacturers of prescription NSAIDs and the COX-2 inhibitor celecoxib (Celebrex) to include with their products a boxed warning emphasizing the increased risk for cardiovascular events and GI bleeding in people taking these drugs.

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The FDA also requested that manufacturers of over-the-counter NSAIDs revise their labels to include more specific language concerning potential cardiovascular and GI risks. Due to its proven heart benefits, aspirin was excluded from these labeling revisions.

Frequent Users

NSAIDs. Anyone who uses NSAIDs regularly is at risk for gastrointestinal problems. Even low-dose aspirin (81 mg) may pose some risk, although the risk is lower than with higher doses. The highest risk is among people who use very high-dose NSAIDs over a long period of time, especially patients with rheumatoid arthritis. Other people who take high doses of NSAIDs include those with chronic low back pain, fibromyalgia, and chronic headaches.

Compared to NSAIDs, COX-2 inhibitors may pose less risk for uncomplicated ulcers, but these medications do not seem to reduce the risk of more serious events, such as bleeding or perforation.

Contributing Factors. Certain factors may increase the risk for ulcers in NSAID users:

Being age 65 or older
Having a history of peptic ulcers or upper gastrointestinal bleeding
Having other serious ailments, such as congestive heart failure
Using other medications, such as the anticoagulant warfarin (Coumadin), corticosteroids, or the osteoporosis drug alendronate (Fosamax)
Abusing alcohol
Being infected with H. pylori