Nonsteroidal Anti-inflammatory Drug Use and Increased Risk for Peptic Ulcer Disease in Elderly Persons

Abstract

These data support other findings indicating that a clinically significant risk for serious ulcer disease is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. The data show that this risk increases with dose and recency of use and that use of these drugs may be responsible for a large proportion of peptic ulcer disease among elderly persons.

Individual NSAIDs and Upper Gastrointestinal Complications

“…Variations in cut-off values were, in general, small except for those used for ibuprofen (200 mg) and naproxen (220 mg) in one study,[14] and for ibuprofen (≪2400 mg) in another study. [33] RRs for the use of high daily doses of NSAIDs were approximately 2- to 3-fold greater than RRs for low-medium doses (figure 3). The pooled RR for high daily dose of ibuprofen was similar to that for high daily dose of diclofenac.…”

“…Selected characteristics of the 28 studies included in the meta-analysis are summarized in table I; 3 studies were cohort studies,[20,24,26] 10 were nested case-control studies,[7,11,17–19,23,25,33,35,67] and 15 were case-control studies. [12–16,21,22,27–32,34,68] Twelve studies, all case-control studies, were field studies collecting individual information by standardized questionnaires.…”

“…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.…”

“…[14,17,33,68] The site of complication was defined as gastric and/or duodenal in all studies, and two included oesophageal complications. [12,32] Most studies, both field and database studies, required information from endoscopy or other diagnostic procedures to confirm UGIC.…”

“…[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...…”