Medical Health Encyclopedia

Contributing Factor s. Certain factors add to the risk for ulcers in NSAID-users:

• People older than age 65.
• Anyone with a history of peptic ulcers or upper gastrointestinal bleeding.
• Those with other serious ailments, such as heart disease or congestive heart failure.
• NSAID users who also take certain other medications, such as the anticoagulant warfarin (Coumadin), corticosteroids, or the osteoporosis drug alendronate (Fosamax).
• Alcohol abusers. Excessive alcohol use may intensify the risk of bleeding in those who also take NSAIDs. (Some studies have shown that alcohol may actually protect against H. pylori.) In any case, everyone should avoid excessive use of alcohol.
• People who take NSAIDs and are infected with the H. pylori bacteria. A 2002 study reported that the combination poses a 3. 5-fold greater risk of ulcers than either one of these factors. (Not all studies report the higher risk in infected patients.)

Other Risk Factors for Ulcers from Either H. Pylori or NSAIDs

Stress and Psychological Factors. Although stress is no longer considered to play a causal role in ulcers, studies still suggest that stress may predispose someone to ulcers or help sustain existing ulcers. Some experts, in fact, estimate that social and psychological factors play a contributory role in 30% to 60% of peptic ulcer cases, whether they are caused by H. pylori or NSAIDs. In any case, some experts believe that the anecdotal relationship between stress and ulcers is so strong that attention to psychological factors is still warranted.

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Smoking. Smoking increases acid secretion, reduces prostaglandin and bicarbonate production, and decreases mucosal blood flow. Results of studies on the actual effect of smoking on ulcers, however, are mixed. Some evidence suggests that smoking delays the healing of gastric and duodenal ulcers. One study reported that after ulcers healed, about half of nonsmokers relapsed after a year, but that all heavy smokers relapsed after three months. Other studies have found no increased risk for ulcers in smokers. In any case, any impact of smoking on ulcers does not seem to be affected by the presence of H. pylori. This should not give smokers any comfort, however, given the other proven dangers from smoking.

Tobacco use and exposure may cause an acceleration of coronary artery disease and peptic ulcer disease. It is also linked to reproductive disturbances, esophageal reflux, hypertension, fetal illness and death, and delayed wound healing.