Na?ve current users of ASA were split into three groups: those who did not receive a PPI prescription at any point between their first ASA prescription and their index date (non-users); those who were prescribed a PPI at the same time as their first ASA prescription; and those who were not prescribed a PPI at the time of first ASA prescription but received a PPI prescription afterwards. Patients who received a PPI prescription sometime after their first ASA prescription had a significantly increased risk of developing uncomplicated PUD compared with nonusers of a PPI (OR: 2.29; 95% CI: 1.45C3.63). analyses were carried out using Stata SE (version 12.0; StataCorp, College Station, Texas, USA). For patients who received an uncomplicated PUD diagnosis, ASA, NSAID and PPI use was also ascertained in the year following their date of diagnosis (as recorded in their medical records). The analysis of data from the THIN database 17-DMAG HCl (Alvespimycin) was approved by the Multicentre Research Ethics Committee (REC reference 07/MRE05/18) and patient records were anonymized and de-identified prior to analysis. All authors had access to the study data and reviewed and approved the final manuscript. Results Patient Characteristics and Comorbidities The demographics and lifestyle characteristics at the index date for the 3, 914 patients who received a diagnosis of uncomplicated PUD during the study period and the 9,969 controls are shown in Table 17-DMAG HCl (Alvespimycin) 1, along with comorbidities significantly associated with the development of uncomplicated PUD (the unadjusted odds ratios [OR] are presented in Table S1). Uncomplicated PUD was significantly associated with being a current or former smoker, having had at least two PCP visits or one or more specialist referrals in the year before the index date, and having had a score of at least 3 on the Townsend deprivation index. Among the comorbidities, stress, depression, gastroesophageal reflux disease and having upper GI symptoms (including nausea, vomiting, dyspepsia, heartburn and epigastric pain) were all significantly associated with uncomplicated PUD development. Table 1 Patient demographics and lifestyle characteristics at the index date, and comorbidities significantly associated with uncomplicated PUD development, in a UK primary care population during 1997C2005. is presented in Table S4. The results should be interpreted with caution, given that it is not possible to ascertain the rationale for whether or not status was determined among patients in the database, and infection status was not available for control individuals. Gastroprotective Medication It was reasoned that the positive Cryab association between uncomplicated PUD development and the use of 17-DMAG HCl (Alvespimycin) PPIs and H2RAs was probably due to confounding by indication (i.e. the fact that these medications are used to treat upper GI symptoms and complications). To test this hypothesis, we analyzed the association between PPI use and the risk of uncomplicated PUD development in the subgroup of na?ve users of ASA. Na?ve current users of ASA were split into three groups: those who did not receive a PPI prescription at any point between their first ASA prescription and their index date (non-users); those who were prescribed a PPI at the same time as their first ASA prescription; and those who were not prescribed a PPI at the time of first ASA prescription but received a PPI prescription afterwards. Patients who received a PPI prescription sometime after their first ASA prescription had a significantly increased risk of developing uncomplicated PUD compared with nonusers 17-DMAG HCl (Alvespimycin) of a PPI (OR: 2.29; 95% CI: 1.45C3.63). In contrast, this association was not apparent among patients who received a PPI at the same time as their first ASA prescription, compared with nonusers of a PPI (OR: 0.86; 95% CI: 0.42C1.78 for patients with continuous PPI use until the index date) (Table 4, the unadjusted values are presented in Table S5). These results suggest that PPI use does not increase the risk of uncomplicated PUD and that the observed association with uncomplicated PUD is due to PPI prescription to treat upper GI symptoms, possibly associated with undiagnosed PUD. Table 4 Association between PPI use and uncomplicated PUD development in na?ve current ASA users in a UK primary care population during 1997C2005.
CasesControlsAssociationa n?=?350n?=?541n (%)n (%)OR (95% CI)No PPI253 (72.3)452 (83.5)1.00PPI at first ASA prescription38 (10.9)49 (9.1)1.27 (0.79C2.04)Continuous until index date13 (3.7)24 (4.4)0.86 (0.42C1.78)Non-continuous25 (7.1)25 (4.6)1.66 (0.91C3.04)PPI added after first ASA prescription59 (16.9)40 (7.4)2.29 (1.45C3.63) Open in a separate window Abbreviations: ASA, acetylsalicylic acid; CI, confidence interval;.