Case-control study on the association of upper gastrointestinal bleeding and nonsteroidal anti-inflammatory drugs in Japan

Abstract

NSAIDs including loxoprofen increase the risk of UGIB in Japan as in Western countries, with a similar magnitude of association. There was no evidence of biological interaction between NSAIDs and H. pylori infection.

Individual NSAIDs and Upper Gastrointestinal Complications

“…Cases were defined as hospitalization or referral to a specialist for upper GI bleeding in 13 studies,[12,15,16,19–22,27–30,33,34] and for bleeding and/or perforation in 15 other studies; four studies also included cases of uncomplicated peptic ulcer. [14,17,33,68] The site of complication was defined as gastric and/or duodenal in all studies, and two included oesophageal complications.…”

“…Six studies conducted in healthcare databases did not conduct any validation of the cases identified. [14,17–20,68] Sixteen studies reported aggregate results for patients with and without a history of UGIC,[7,12–14,16,20–23,28,31–34,67,68] and 12 provided results for patients without a history of UGIC;[11,15,17–19,24–27,29,30,35] the remaining study was a case-crossover study. [14] Most studies excluded subjects with a history of a known cause of UGIC, including the use of gastrotoxic medications and life-threatening diseases (table II).…”

“…Four studies did not have any exclusion criteria. [20,22,28,34] Among the 14 case-control studies, seven included hospital controls;[12,13,16,21,29–31] five included both hospital and community controls;[22,27,28,32,34] one included community controls;[15] and two were case-crossover studies. [14,68] All case-control studies were matched on age, sex (except one study[16]), hospital or geographic area, and index date.…”

“…[17] In addition to age and sex, the most frequent confounders considered were a history of peptic ulcer (21 studies),[7,11,15–31,35,67] smoking (13 studies),[7,11,15,18,20,21,23,27–32] alcohol use (9 studies),[7,15,19,21,27,28,30–32] use of proton-pump inhibitors and anti-ulcer medications (11 studies),[16–23,30,67,68] and concurrent use of medications increasing the risk of UGIC (16 studies). [7,11,15,16,19–21,23,27,29–31,33,35,67,68] The quality of the studies measured with the NOS was, in general, very good: for the selection component, 12 studies had the maximum score of 4[7,11,15,22–25,32,33,35,67,68] and 13 studies had the next highest score of 3;[13,14,16–19,21,26,28,29,30,32,34] for comparability, 24 studies had the maximum score of 2;[7,11,14–19,21–33,35,67,68] and for the exposure/outcome component, 14 studies had the maximum score of 3[7,11,13,17–19,23–26,33,35,67,68] and 10 studies...…”

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

“…Comment: LDA treatment is associated with a high prevalence and incidence of peptic ulcer bleeding [126][127][128]. Among patients receiving LDA and clopidogrel, prophylactic use of PPI reduced the rate of upper GI bleeding (UGIB) [129].…”