Background: Peptic ulcer bleeding leads to substantial morbidity and mortality in patients with liver cirrhosis, whose long-term risk of recurrent bleeding remains elusive. In order to elucidate the association between cirrhosis and peptic ulcer rebleeding, we conducted this nationwide cohort study by analyzing the Taiwan National Health Insurance Research Database. Methods: From all patients (n=271,030) hospitalized because of peptic ulcer bleeding between January 1997 and December 2006, we identified 9,711 patients with liver cirrhosis and selected 38,844 non-cirrhotic controls matched with 1:4 proportion in age, gender, and use of gastroprotective agents. Cumulative incidences and hazard ratios were analyzed. Results: The cumulative incidences of recurrent bleeding were significantly higher in cirrhotic patients than in controls (1 year: 17.0% vs. 11.9%, 5 year: 36.2% vs. 24.9%, and 10 years: 42.2% vs. 31.0%, all p<0.001). The excessive risk of rebleeding associated with cirrhosis was consistently found in stratified analyses. However, the hazard ratio diminished with age because the rebleeding incidence was high regardless of age in cirrhotic patients, whereas it rose incrementally with age in controls. The multivariate Cox regression analysis verified cirrhosis as an independent risk factor for recurrent peptic ulcer bleeding with an adjusted hazard ratio of 1.43 (95% confidence interval: 1.36-1.50). Conclusion:Liver cirrhosis is independently associated with higher risk of recurrent peptic ulcer bleeding. The high rebleeding rate found in all cirrhotic patients with different demographic characteristics highlights the urgent needs for effective therapies to reduce this long-term risk.
