Nonsteroidal anti-inflammatory drugs (NSAIDs) and alcohol consumption increase the risk for major upper gastrointestinal (GI) bleeding. Use of alcohol and NSAIDs has been proved to be an independent risk factor for upper GI bleeding. The most commonly used NSAIDs are aspirin and ibuprofen, which are readily available over the counter. Previous studies have looked at NSAID use and alcohol consumption as risk factors for upper GI bleeding, but none has determined the combined impact of NSAID and alcohol consumption. This determination is particularly important because of the use of low-dose aspirin in various preventive measures. Kaufman and associates studied the relationship between aspirin and ibuprofen in upper GI bleeding with various levels of alcohol consumption.

Patients who were hospitalized for acute upper GI bleeding caused by gastric or duodenal ulcers or gastritis were enrolled in the study. Randomly selected patients were used as controls for comparison. Subjects were interviewed by questionnaire about demographic information, medical history, alcohol consumption and medications used within the past six months. The information on alcohol consumption included frequency of use, type of beverage, quantities used and date of last consumption.

The study included 1,224 patients who were admitted for upper GI bleeding. As the quantity of alcohol consumption increased, the relative risk of upper GI bleeding also increased, up to a relative risk of 2.8 in heavy alcohol consumers. The use of aspirin increased the risk at all levels of alcohol consumption. With regular use, the relative risk for upper GI bleeding in alcohol consumers taking more than 325 mg of aspirin per day was 7.0. Regular use of ibuprofen was also found to increase the relative risk for upper GI bleeding in alcohol consumers. Occasional use of ibuprofen was not found to increase the risk for upper GI bleeding in patients who drank alcohol.

The authors conclude that aspirin and ibuprofen use in persons who consume alcohol can significantly increase their risk for upper GI bleeding. This was true even in patients who were using low-dose aspirin for cardioprotection or other preventive measures. Physicians need to explore the use of alcohol in all patients to whom they recommend aspirin or ibuprofen therapy.

editor's note: One of the more common preventive measures is the use of one aspirin per day. In addition, the use of prescription and over-the-counter NSAIDs is common. This study points out the importance of discussing the use of NSAIDs and taking a good history concerning alcohol use. Even low-dose aspirin was associated with an increased risk for major GI bleeding. In order to reduce this risk, physicians should assess alcohol use before recommending NSAID use.—k.e.m.