Is there an endoscopic and prognostic difference between bleeding post-non-steroidal anti-inflammatory drugs bulbar (NSAID) ulcers and non-NSAID bulbar ulcers?

Aims Digestive toxicity caused by non-steroidal anti-inflammatory drugs (NSAIDs) is frequent. It is sometimes serious, particularly when it leads to peptic ulcer haemorrhage. The aim of this study was to compare the endoscopic and prognostic status of post-NSAID hemorrhagic ulcers with that of non-NSAID bulbar ulcers.

Methods This was a retrospective- descriptive and analytical study in the Gastroenterology Department, over a 25-month period. All upper gastrointestinal bleeding secondary to bulbar ulcer was included, and we compared the endoscopic and prognostic profile of patients on NSAIDs and those who did not take NSAIDs.

Results One hundred and two cases (102) of hemorrhagic bulbar ulcers were included. NSAID use prior to bleeding was noted in 40.8% (n=40) of patients. Comparing the groups of patients taking NSAIDs (group A) and those not taking NSAIDs (group B), we found the following results: There was a clear male predominance in both groups. The mean age of patients in the two groups was 54.8 and 52.7 years respectively. There were no statistically significant differences in mean hemoglobin levels, surgical intervention, recurrence of bleeding or transfusion requirements. Bulbar ulcers were classified as Forrest stage III in 54% of cases. in group (A) versus 66.7% in group (B) (p=0.69). In group (A), the ulcer was multiple in 37.5% of cases versus 22.5% in group (B) (p=0.004). In univariate analysis, patients in group (A) required endoscopic treatment in 35% of cases (n=14) versus 5% in group (B) (p=0.03). HP status was positive in 80% (n=32) of patients in group A versus 50% in group B (p=0.054).

Conclusions Our study showed that post-NSAID bulbar ulcers were more likely to have multiple locations and require more endoscopic treatment than non-NSAID bulbar ulcers, demonstrating the severity of digestive bleeding associated with NSAIDs. The combination of HP and NSAIDs also increases the risk of ulceration.

Publication History

Article published online:
27 March 2025