Preventing the Development of Peptic Ulcer Disease

Peptic Ulcer Disease (PUD) is often the more prevalent cause of gastrointestinal bleeding.  It is commonly thought that ulcers are caused by consuming too much spicy food, but this is in fact a myth. 

PUD can be caused by a variety of things, but is most commonly due to nonsteroidal anti-inflammatory drugs (NSAIDs) and Helicobactor pylori (H. pylori).  H. pylori caused ulcers have decreased in occurrence thanks to the increase in overall hygiene of many countries.  Unfortunately, some countries still have high number of PUD cases.  It has then become evident that the reason PUD is still so prevalent is due to NSAIDs.  NSAIDs are those over the counter pain relievers many of us rely on heavily to get us through the day.  These include aspirin, ibuprofen, naproxen, etc..

The image above shows the warning on common NSAIDs that many of us ignore.

Peptic Ulcers seem to affect many people in this day and age, as is the popularity of medications that decrease cholesterol in the blood.  Just within my immediate family, there are three who complain about their ulcers and four that are on cholesterol lowering medications; one applies to both.  I am curious to see what the effect these medications have on the development of peptic ulcers.  With the increase in the popularity of cholesterol lowering medications and the number of individuals with peptic ulcers, there is bound to be overlap.  We should all be concerned over the effect medications like these have on the development of peptic ulcers due to their popularity.    

Statins are hydroxymethylglutaryl coenzyme A reductase inhibitors that prevent the synthesis of cholesterol within the body, specifically the liver.  Basically, statins are prescribed to individuals that need help lowering their levels of cholesterol in the blood.  Statins have recently been linked to lowering the frequency of PUD development when combined with antithrombotic treatment (anticlotting therapy) and NSAIDs, but this connection has only been made in animals and the effectivity of the treatment in humans is still under question.  This specific experiment looked into the connection statins have on PUD in humans.

The research was conducted in Taiwan because the government has a state-run National Health Insurance program.  This basically just means that 99% of the population has universal health coverage.  The data for the experiment was collected through the National Health Insurance Research Database which tracks all inpatient and outpatient care, including prescriptions, diagnosis, and even sex and date of birth of the patient.  One million cases were randomly selected form the database dating from 1998 to 2011.  The patients’ personal information was kept private allowing the research team to analyze the cases anonymously.

                                             Find the image here.

In order to determine if there was a connection with stains and PUD, patients had to be newly diagnosed with hyperlipidemia (high lipid or fat levels within the blood).  These individuals were broken further into two groups.  The first group was patients that had undergone statin treatment for at least 90 days and the second was for those treated without statins.  The criteria for all patients were that they had to be older than 20 years old and not previously diagnosed with PUD.  The baseline comorbidities were hypertension, stroke, coronary artery disease, and end stage renal disease.  They also included the simultaneous usage of NSAIDs.      

 A Chi-square test and the Mann-Whitney U test were used to compare the statin group versus the non-statin group.  The median age was determined be slightly over 55 for both groups.  No significant differences were found within sex or age of the patient.  It was determined that of the 24,423 patients in the statin treatment group, 4,145 developed PUD (33.5 of 1,000 people).  Of the 24,139 that didn’t undergo statin treatment, 5,026 developed PUD (45.0 of 1,000 people).  The occurrence of PUD also was noted to increase with age in both men and women.  Within both groups, the usage of NSAIDs increased the incidence of PUD.   The development of PUD was often directly correlated to the high doses of NSAIDs elderly individuals’ use. 

Statins showed to decrease the chance of developing PUD, even with continuous use of NSAIDs.  It was noted that many of the patients in the study with PUD were infected with H. pylori, but many of them refused endoscopic biopsy to confirm the cause of the PUD.  Many factors play a role in the development of PUD, but there may be a light at the end of the tunnel for those at risk.

With future research, statins may be the future preventive prescription given to those at risk for developing PUD.  By repeating this study with less limitation, researchers can better understand how statins interfere with the formation of peptic ulcers.  In future studies it would be helpful to have access to biopsies, patient diet, and patient habit information such as physical activities.  

Learn more here.

References:

Feng, A., Chuang, E., Wu, S., Wang, J., Chang, S., Lin, C., Kao, C. (2015).  The Effect of Statins on the Occurance of Peptic Ulcer.  European Journal of Internal Medicine, 26(9), pages: 731-735. Retrieved from: 10.1016/j.ejim.2015.07.015

Image from:

dokidok (2008).  Peptic ulcer disease, Retrieved from flickr.