Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other nonnarcotic analgesics

Levy, Micha

doi:10.1001/archinte.148.2.281

Cited by 70 publications

(16 citation statements)

References 32 publications

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“…This may be due to chance or to the fact that children may have a higher sensitivity to NSAIDs side effects. Alternative explanations may be that primary exposure to the drugs may be associated with higher risk, which is the case in adults [18], or to the so-called depletion of susceptible effect that we previously demonstrated to occur with NSAIDs and UGIB in adults [19] (people at risk tend to be withdrawn from the opportunity to exposure and to subsequently develop disease more and more with time). The number of cases reported in the younger age groups was indeed proportionally much higher than in older children.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study

Grimaldi-Bensouda

Abenhaim

Michaud

et al. 2010

Eur J Clin Pharmacol

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Objective This population-based survey was conducted to provide a formal description of upper gastrointestinal bleeding (UGIB) in children on a nationwide basis and assess the contribution of risk factors, principally nonsteroidal anti-inflammatory drugs (NSAID). Methods A case-crossover study of UGIB patients aged between 2 months and 16 years was conducted in France. Medical data were collected by physicians, and personal risk factors and exposure to drugs during the month preceding the onset of the bleeding was ascertained by a standardised telephone interview with parents. The odds ratios for UGIB and NSAID was assessed by comparing exposure during the 7 days preceding the date of hospitalisation and the 21st to the 28th days before that date.Results A total of 177 children with UGIB were included over 2 years. Eighty-three children had taken at least one NSAID before the index date, among which 58 were ibuprofen, 26 aspirin and nine others. The adjusted odds ratio (OR) of exposure was 8.2 [95% confidence interval (CI) 2.6-26.0] for NSAIDs altogether, and this was 10.0 (95% CI 2.0-51.0) for ibuprofen and 7.3 (95% CI 0.9-59.4) for aspirin. There was no increased risk associated with NSAIDS for oesophageal lesion [OR=1.0 [(5% CI:0.2-7.2)]. Conclusion The study confirms that UGIB is rare but that some cases may be avoided, as one third of the cases was attributable to exposure to NSAID at doses used for analgesic or antipyretic purposes, which may be attained with alternative therapy. The findings from this study call for more caution in prescribing NSAIDS to children.

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Section: Discussionmentioning

confidence: 99%

Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study

Grimaldi-Bensouda

Abenhaim

Michaud

et al. 2010

Eur J Clin Pharmacol

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“…[32,33] The literature now confirms that up to 0.5% of ulcer bleeds occur with long term NSAID use. [34,35] Such data, however, must be corrected for patients at greater risk of adverse effects associated with long term NSAID use. Thus, while Carson and colleagues [36] reported a 1.5 risk ratio, this population included younger patients and was not corrected for over-the-counter NSAID use, which is common in this population.…”

Section: Epidemiological Basismentioning

confidence: 99%

“…Levy [34] has documented that ingestion of up to 12 aspirin 300mg tablets daily for periods of no more than 4 to 5 days can cause gastric bleeding. Numerous reports have documented the gastrotoxicity of aspirin on endoscopic examination.…”

Section: 1 Salicylatementioning

confidence: 99%

From Peptic Ulcer Disease to NSAID Gastropathy

Roth¹

1995

Drugs & Aging

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Nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy is an important clinical entity, most commonly encountered in elderly female patients. The expanding use of NSAIDs in the elderly population has led to an increased incidence of NSAID-induced gastropathy. The risk of gastric bleeding in these patients is 7-fold higher than in the younger population. Long term NSAID therapy in the elderly is apparently associated with failure of normal gastric mucosal adaptation. Silent unidentified gastric lesions are likely to be common with long term NSAID therapy, as symptomatology does not parallel pathological progression. This gastropathy, in contrast to peptic ulcer disease, is responsive to prostaglandins and other cytoprotective agents. A new generation of prostaglandin-sparing NSAIDs (e.g. nabumetone), in addition to the older nonacetylated salicylates, may represent less gastrotoxic alternatives. Therefore, these agents may substantially reduce the risk of NSAID-induced gastropathy. The debate continues as to whether to use NSAIDs, and under which circumstances. More importantly, the cost-benefit implications and justification for concomitant therapy with gastroprotective agents cloud the picture. Currently, there is a definite consensus that NSAIDs should not be casually used on a chronic basis, especially in patients at risk for serious gastropathy complications. In all cases, where possible, gastric prostaglandin-sparing NSAIDs or nonacetylated salicylates should be used in lowest effective dosages. In special circumstances, gastroprotective co-therapy can be considered. NSAID therapy probably should not be used or continued in elderly patients with a history of bleeding ulcers or recent major gastric ulcer activity.

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“…This applies, for example, to the risk of gastrointestinal bleeding during NSAID treatment [18,19] a condition characterised by a high incidence and a group of drugs in common use.…”

Section: Referencesmentioning

confidence: 99%

Comparing risk estimates of sulphonamide-induced agranulocytosis from the Swedish Drug Monitoring System and a case-control study

Keisu

Ekman

Wiholm

1992

Eur J Clin Pharmacol

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A comparison has been made of risk estimates for agranulocytosis connected with sulphasalazine and trimethoprim-sulphamethoxazole (T-SM) therapy calculated from data in the Swedish Drug Monitoring System ("spontaneous" reports, sales and prescription information) and a population based case-control study (the IAAAS). The relative risk for agranulocytosis during sulphasalazine treatment was calculated to be 107 and 123 by the spontaneous reporting system and the case-control study, respectively. The corresponding excess risk in both systems was 1.8. For T-SM the relative risk was 17 in the spontaneous reporting system and 12 in the case-control study, while the excess risk calculated for 3 days of treatment was 0.9 in the spontaneous reporting system, and 1.6 for 3 or more days of treatment in the case-control study. It is concluded that the Swedish Drug Monitoring System gives an appropriate estimate of the risk of developing agranulocytosis in association with the two drugs studied.

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Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other nonnarcotic analgesics

Cited by 70 publications

References 32 publications

Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study

Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study

From Peptic Ulcer Disease to NSAID Gastropathy

Comparing risk estimates of sulphonamide-induced agranulocytosis from the Swedish Drug Monitoring System and a case-control study

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