Small bowel ulcerative lesions are common in elderly NSAIDs users with peptic ulcer bleeding

Table 1 Demographic and disease related characteristics of bleeders and controls

Characteristic	Patients (n = 60)	Controls (n = 60)	P
Mean age (yr)	75 (SD = 8)	74 (SD = 9)	0.26
Male gender	44 (73%)	44 (73%)	1.00
Active smoking	18 (30%)	18 (30%)	1.00
Alcohol abuse	12 (20%)	12 (20%)	1.00
BMI > 25	36 (60%)	36 (60%)	1.00
NSAIDs consumption	40 (67%)	40 (67%)	1.00
Ischaemic heart disease	20 (33%)	20 (33%)	1.00
Chronic pain	6 (10%)	22 (37%)	0.006
Diabetes melitus	11 (18%)	12 (20%)	0.82
COPD	4 (7%)	4 (7%)	1.00
Low dose aspirin use1	22 (37%)	22 (37%)	1.00
Non aspirin NSAIDs use1	24 (40%)	24 (40%)	1.00
COX-2 selective use	6 (10%)	6 (10%)	1.00
Non selective NSAIDs use	18 (30%)	18 (30%)	1.00
Clopidogrel co-administration	12 (20%)	12 (20%)	1.00
Gastric passing time (min)	41 (SD = 49)	42 (SD = 57)	0.46
Small bowel passing time (min)	221 (SD = 117)	271 (SD = 117)	0.01
H. pylori positive	37 (60%)	37 (62%)	1.00

¹Three bleeders and 6 controls received both low-dose aspirin and non-aspirin NSAIDs. SD: Standard deviation; NSAIDs: Non-steroidal anti-inflammatory drugs; BMI: Body mass index; COPD: Chronic obstructive lung disease; COX-2 selective use: Cyclooxygenase-2 selective inhibitors.

Table 2 Small bowel mucosal lesions found during video capsule endoscopy in both bleeders and controls

Patient group	Cases	Controls	P
All patients	n = 60	n = 60
Grade 4 lesions	22 (37%)	4 (8%)	0.0001
Grade 3 lesions	40 (67%)	18 (30%)	0.0001
Grade 2 lesions	41 (68%)	21 (35%)	0.0003
Grade 1 lesions	42 (70%)	28 (47%)	0.0100
NSAID consumers	n = 40	n = 40
Grade 4 lesions	22 (55%)	4 (10%)	< 0.0001
Grade 3 lesions	39 (95%)	17 (33%)	< 0.0001
Grade 2 lesions	40 (100%)	20 (50%)	< 0.0001
Grade 1 lesions	40 (100%)	26 (65%)	< 0.0001
No-NSAID consumers	n = 20	n = 20
Grade 4 lesions	0	0
Grade 3 lesions	1 (5%)	1 (5%)	1.00
Grade 2 lesions	1 (5%)	1 (5%)	1.00
Grade 1 lesions	2 (10%)	2 (10%)	1.00

NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 3 Number of mucosal lesions found during video capsule endoscopy in both bleeders and controls consuming non-steroidal anti-inflammatory drugs, after stratification according to the type of non-steroidal anti-inflammatory drug consumed

Patient group	Patients	Controls	P
All patients	n = 40	n = 40
Jejunum
Grade 4 lesions	1 (SD = 2)	0.3 (SD = 0.7)	0.02
Grade 3 lesions	10.8 (SD = 4.3)	1 (SD = 0.6)	< 0.0001
Ileum
Grade 4 lesions	1.1 (SD = 1.9)	0.2 (SD = 0.3)	0.002
Grade 3 lesions	8.1 (SD = 4.8)	1.2 (SD = 2.2)	< 0.0001
Low dose aspirin users	n = 22	n = 22
Jejunum
Grade 4 lesions	0.8 (SD = 1.3)	0.2 (SD = 0.4)	0.02
Grade 3 lesions	9.9 (SD = 4.7)	0.8 (SD = 0.5)	< 0.0001
Ileum
Grade 4 lesions	0.9 (SD = 1.4)	0.1 (SD = 0.3)	0.006
Grade 3 lesions	10.3 (SD = 4.6)	1 (SD = 1.6)	< 0.0001
Non-aspirin NSAID consumers	n = 24	n = 24
Jejunum
Grade 4 lesions	1.4 (SD = 2.6)	0.4 (SD = 0.9)	0.04
Grade 3 lesions	11.9 (SD = 3.8)	1.2 (SD = 0.7)	< 0.0001
Ileum
Grade 4 lesions	1.6 (SD = 2.4)	0.3 (SD = 0.3)	0.02
Grade 3 lesions	7.7 (SD = 4.8)	1.4 (SD = 2.3)	< 0.0001
COX-2 NSAID consumers	n = 6	n = 6
Jejunum
Grade 4 lesions	0.3 (SD = 0.6)	0	0.27
Grade 3 lesions	5.7 (SD = 6.7)	0.4 (SD = 1.4)	0.04
Ileum
Grade 4 lesions	0.7 (SD = 1.2)	0	0.15
Grade 3 lesions	6.7 (SD = 5.7)	0.5 (SD = 0.7)	0.01

NSAIDs: Non-steroidal anti-inflammatory drugs; SD: Standard deviation; COX-2: Cyclooxygenase-2 selective inhibitors.

Table 4 Logistic regression analysis of demographic characteristics and co-morbidities related to a hemorrhage recurrence possibly related to the small bowel

Characteristic	Relative risk	Confidence intervals	P
Age	1.03	0.96-1.10	0.40
Male gender	3.63	0.61-21.46	0.15
Body mass index	1.22	0.90-1.63	0.19
Diabetes	2.14	1.35-3.40	0.001
Chronic obstructive lung disease	6.67	1.01-46.3	0.05
Absence of small bowel ulcers	0.13	0.01-0.99	0.05