What is the highest risk factor for peptic (duodenal or gastric) ulcer disease?

From the Guidelines

The highest risk factor for peptic ulcer disease is a history of peptic ulcer and/or ulcer complication, which carries the highest relative risk for NSAID-associated upper GI complications. This is based on the study by Angel Lanas, MD, PhD, published in Clinical Gastroenterology and Hepatology in 2006 1. According to this study, peptic ulcer and/or ulcer complication history is the most significant risk factor, and this risk can be modified by factors such as H pylori infection and NSAID use.

Key Risk Factors

• A history of peptic ulcer and/or ulcer complication
• H pylori infection
• NSAID use
• Other factors such as smoking, excessive alcohol consumption, and family history may also contribute to the risk of peptic ulcer disease, but they are not as strongly associated with the disease as a history of peptic ulcer and/or ulcer complication.

Management

For patients with a history of peptic ulcer and/or ulcer complication, H pylori eradication is a therapeutic option that can reduce NSAID-associated GI toxicity 1. Additionally, co-therapy with drugs that modify NSAID-induced pathogenic mechanisms, such as misoprostol or antisecretory therapy with H2-RA and PPI, may also help reduce the risk of peptic ulcer disease. PPIs, in particular, have been shown to significantly reduce gastric and duodenal ulcers associated with NSAID use 1.

Treatment

For patients with suspected peptic ulcers, testing for H. pylori is essential, and if detected, standard treatment involves a 10-14 day course of triple therapy, including a proton pump inhibitor and two antibiotics. Eradication of H. pylori significantly reduces ulcer recurrence rates 1.

From the Research

Risk Factors for Peptic Ulcer Disease

The highest risk factor for peptic (duodenal or gastric) ulcer disease is associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3, 4, 5, 6.

• Key risk factors for NSAID-related gastric injury include:
  • Age >70 years 2, 6
  • History of ulcer disease 2, 3, 4, 6
  • Use of multiple agents (e.g., > or =2 NSAIDs, or an NSAID plus aspirin--even at cardioprotective doses) 2, 3
  • High doses of an NSAID 2
  • Concurrent use of corticosteroids or anticoagulants 2, 3, 6
• Infection with Helicobacter pylori can produce additive or synergistic gastric mucosal injury in NSAID users 2, 3, 5
• The use of NSAIDs increases the risk of peptic ulcer 3- and 5-fold in H. pylori-positive and H. pylori-negative patients, respectively 5