Risk for Serious Gastrointestinal Complications Related to Use of Nonsteroidal Anti-inflammatory Drugs

Gabriel, Sherine E.; Jaakkimainen, Liisa; Bombardier, Claire

doi:10.7326/0003-4819-115-10-787

Cited by 1,137 publications

(531 citation statements)

References 46 publications

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“…The list of characteristics was based on literature about the methods of epidemiologic studies in general and on previous meta-analyses on anti-in¯ammatory drugs and UGIC [6,7,59]. Data from articles was abstracted in duplicate and entered into a database.…”

Section: Methodsmentioning

confidence: 99%

“…Based on the general population, early observational studies have reported risks of upper gastrointestinal complications (UGIC) from 1 to 10 times higher among aspirin users, with an estimated pooled relative risk between 2 and 3 [6,8], Nonetheless, the fact that aspirin is widely available over-the-counter without prescription complicates the assessment of its effects in observational studies.…”

Section: Introductionmentioning

confidence: 99%

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Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

Rodrı́guez

Hernández–Dı́az

Abajo³

2001

Brit J Clinical Pharma

248

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Aims Because of the widespread use of aspirin for prevention of cardiovascular diseases, side-effects associated with thromboprophylactic doses are of interest. This study summarizes the relative risk (RR) for serious upper gastrointestinal complications (UGIC) associated with aspirin exposure in general and with speci®c aspirin doses and formulations in particular.Methods After a systematic review, 17 original epidemiologic studies published between 1990 and 2001 were selected according to prede®ned criteria. Heterogeneity of effects was explored. Pooled estimates were calculated according to different study characteristics and patterns of aspirin use. Results The overall relative risk of UGIC associated with aspirin use was 2.2 (95% con®dence interval (CI): 2.1, 2.4) for cohort studies and nested case-control studies and 3.1 (95% CI: 2.8, 3.3) for non-nested case-control studies. Original studies found a dose±response relationship between UGIC and aspirin, although the risk was still elevated for doses lower or up to 300 mg day x1 . The summary RR was 2.6 (95% CI: 2.3, 2.9) for plain, 5.3 (95% CI: 3.0, 9.2) for buffered, and 2.4 (95% CI: 1.9, 2.9) for enteric-coated aspirin formulations. Conclusions Aspirin was associated with UGIC even when used at low doses or in buffered or enteric-coated formulations. The latter ®ndings may be partially explained by channeling of susceptible patients to these formulations.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

Rodrı́guez

Hernández–Dı́az

Abajo³

2001

Brit J Clinical Pharma

248

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“…Several systematic reviews have attempted to provide estimates of the risks of upper GI complications of NSAIDs (7)(8)(9)(10)(11). With 1 exception, these reviews have focussed on perforations, ulcers, or bleeds.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of dyspepsia and nonsteroidal antiinflammatory drugs

Ofman¹,

MacLean²,

Straus³

et al. 2003

Arthritis & Rheumatism

107

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Objective. Nonsteroidal antiinflammatory drug (NSAID) use is a known risk factor for gastrointestinal (GI) perforations, ulcers, and bleeds, but there are limited data on its association with the very common symptom of dyspepsia. Using published and unpublished data sources, we sought to determine estimates of the risks of dyspepsia associated with NSAIDs. Methods. We searched computerized databases (1966 -1998) for primary studies of NSAIDs reporting on GI complications. We also obtained Food and Drug Administration (FDA) new drug application reviews for the 5 most common NSAIDs. We included studies reporting defined upper GI outcomes among subjects (>17 years old) who used oral NSAIDs for more than 4 days. Two reviewers evaluated 4,881 published titles, identifying 55 NSAID versus placebo randomized controlled trials (RCTs), 37 unpublished (FDA data) placebo-controlled RCTs; 86 NSAID versus NSAID RCTs (sample size >50); and 103 observational studies.

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“…All drug categories were mentioned in all settings; NSAIDs were mentioned most frequently at 51.2% of drug visits for arthritis (data not shown). Little data exist to judge the appropriateness of this rate of NSAID orders, but the documented adverse health effects (31)(32)(33) and economic (34) consequences of NSAID use support other studies (35,36) suggesting this is potentially a large medical and public health problem. We could not assess the effect of the availability of COX-2 inhibitors, introduced after 1997, on the rate of NSAID orders during arthritis visits; this is an important area for future research.…”

mentioning

confidence: 99%

Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits, United States, 1997

Hootman¹,

Helmick²,

Schappert³

2002

Arthritis & Rheumatism

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Objective. To describe ambulatory medical care utilization, defined to exclude injury-related visits, for persons with arthritis and other rheumatic conditions. Methods. National estimates, rates, and other characteristics of ambulatory care visits were calculated from a national sample of patient visits to physician offices and acute care hospital outpatient and emergency departments.Results. An estimated 36.5 million ambulatory care visits were related to arthritis and other rheumatic conditions. Visit rates increased with age and, overall, were twice as high among women as men. Rates of visits by race varied by ambulatory care setting. Soft tissue disorders (9.3 million), osteoarthritis (7.1 million), nonspecific joint pain/effusion (7.0 million), and rheumatoid arthritis (3.9 million) were the most common diagnoses. Conclusions. Arthritis and other rheumatic conditions account for about as many ambulatory care visits as cardiovascular disease or essential hypertension. These visits serve as excellent opportunities to counsel patients regarding prevention messages for arthritis.

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Risk for Serious Gastrointestinal Complications Related to Use of Nonsteroidal Anti-inflammatory Drugs

Cited by 1,137 publications

References 46 publications

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

Association between aspirin and upper gastrointestinal complications: Systematic review of epidemiologic studies

Meta‐analysis of dyspepsia and nonsteroidal antiinflammatory drugs

Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits, United States, 1997

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