MedWire News: Patients with perforated or bleeding peptic ulcers who also suffer from chronic obstructive pulmonary disease should be monitored closely, say researchers who found that patients with the lung condition had a significantly increased short-term risk of death compared with patients with ulcers alone.
"Over the last decade, evidence has accrued that smokers and patients with chronic obstructive pulmonary disease are at increased risk of peptic ulcer disease, including complicated diseases such as perforated and bleeding peptic ulcers," explain Dr Steffen Christensen, from Aarhus University Hospital in Denmark, and colleagues.
"But limited data exist on whether chronic obstructive pulmonary disease influences short-term mortality among patients with bleeding and a perforated peptic ulcer," they add.
To investigate, the team studied data on 2033 Danish patients with perforated peptic ulcers and 7486 with bleeding peptic ulcers who received hospital treatment for their condition between 1991 and 2004.
The researchers used the patients' medical records to identify all those who had been treated for chronic obstructive pulmonary disease before being hospitalised for peptic ulcers.
They also examined the Danish death register to identify all those who died within 30 days of receiving hospital treatment for complicated peptic ulcers.
In total, 218 of the ulcer patients had previously been treated for chronic obstructive pulmonary disease.
Analysis revealed that 44% of perforated ulcer patients who also had chronic obstructive pulmonary disease died within 30 days of being hospitalised for their condition, compared with just 25% of perforated ulcer patients without lung disease.
Among bleeding peptic ulcer patients, 17% of those with chronic obstructive pulmonary disease died within 30 days of receiving treatment, compared with just 11% of those without the lung condition.
Further analysis showed that the use of steroids by ulcer patients with chronic obstructive pulmonary disease significantly increased the risk of ulcer complications.
"We found that chronic obstructive pulmonary disease was associated with a substantially increased 30-day mortality rate among patients who had been hospitalised for perforated and bleeding peptic ulcers," the researchers summarise in the journal Chest.
They add: "Ulcer-preventive medications should be considered for chronic obstructive pulmonary disease patients who are at risk for peptic ulcer disease, in particular for those treated with oral glucocorticoids, which appear to increase both the risk of and mortality from complicated peptic ulcers.
"Also, the high mortality rate among chronic obstructive pulmonary disease patients who had been hospitalised for complicated peptic ulcers underscores the importance of optimising their pre-operative and post-operative supportive care."