Is There an Endoscopic and Prognostic Difference between Bleeding Post-NSAID Bulbar Ulcers and Non-NSAID Bulbar Ulcers?

Abstract

Background: Digestive toxicity caused by non-steroidal anti-inflammatory drugs (NSAIDs) is common and can be severe, particularly when leading to peptic ulcer hemorrhage. This study aimed to compare the endoscopic and prognostic characteristics of post-NSAID bleeding bulbar ulcers with non-NSAID bulbar ulcers. Methods: We conducted a retrospective, descriptive, and analytical study over a 25-month period in the Gastroenterology Department of Hassan II University Hospital of Fez. All cases of upper gastrointestinal bleeding due to bulbar ulcers were included. Patients were divided into two groups: those with NSAID exposure (Group A) and those without (Group B). Endoscopic and prognostic profiles were compared. Results: A total of 102 cases were included. NSAID use was documented in 40 patients (40.8%). Male predominance was observed in both groups. The mean age was 54.8 years in Group A and 52.7 years in Group B. No significant differences were found in hemoglobin levels, need for surgery, rebleeding rates, or transfusion requirements. Forrest stage III classification was observed in 54% of Group A versus 66.7% of Group B (p = 0.69). Multiple ulcers were more frequent in Group A (37.5% vs. 22.5%; p = 0.004). Endoscopic treatment was required in 35% of Group A versus 5% of Group B (p = 0.03). Helicobacter pylori infection was more common in NSAID users (80% vs. 50%; p = 0.054). Conclusion: Post-NSAID bulbar ulcers were more likely to be multiple and to require endoscopic treatment compared with non-NSAID bulbar ulcers, highlighting the severity of NSAID-related digestive bleeding. The coexistence of H. pylori infection and NSAID use further increased ulcer risk.