Non-steroidal anti-inflammatory drugs use and risk of upper gastrointestinal adverse events in cirrhotic patients

• Published in: Liver international Vol. 32; no. 5; pp. 859 - 866
• Main Authors: Lee, Yen-Chieh, Chang, Chia-Hsuin, Lin, Jou-Wei, Chen, Hsi-Chieh, Lin, Min-Shung, Lai, Mei-Shu
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.05.2012
• Subjects: Adult; Aged; Aged, 80 and over; anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Celecoxib; cirrhosis; Comorbidity; Cyclooxygenase 2 Inhibitors - adverse effects; Databases, Factual; Duodenitis - chemically induced; Duodenitis - epidemiology; Duodenitis - pathology; Esophageal and Gastric Varices - chemically induced; Esophageal and Gastric Varices - epidemiology; Esophageal and Gastric Varices - pathology; Female; Gastritis - chemically induced; Gastritis - epidemiology; Gastritis - pathology; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - epidemiology; Gastrointestinal Diseases - pathology; gastrointestinal haemorrhage; Histamine Antagonists - therapeutic use; Humans; Liver Cirrhosis - drug therapy; Liver Cirrhosis - epidemiology; Liver Cirrhosis - pathology; Logistic Models; Male; Middle Aged; non-steroidal; Peptic Ulcer - chemically induced; Peptic Ulcer - epidemiology; Peptic Ulcer - pathology; Proton Pump Inhibitors - therapeutic use; Pyrazoles - adverse effects; Risk Assessment; Sulfonamides - adverse effects; variceal bleeding; Young Adult
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/j.1478-3231.2011.02739.x

Background/Aims The upper gastrointestinal (GI) toxicity associated with non‐steroidal anti‐inflammatory drugs (NSAID) use among cirrhotic patients remains unclear. The objective of this study was to evaluate the risk of upper GI adverse events associated with celecoxib and oral and parenteral non‐selective NSAIDs in cirrhotic patients. Methods All the patients aged ≥ 20 years with a diagnosis of cirrhosis hospitalized for variceal bleeding and non‐variceal upper GI adverse events (oesophageal, gastric, duodenal ulcer, bleeding; gastritis and duodenitis) in 2006 were identified using ICD‐9‐CM diagnosis codes from inpatient claims from the Taiwan National Health Insurance Database. In the case‐crossover study design, the case period was defined as 1–30 days and the control period as 31–60 days before the date of hospitalization. The information for individual NSAID use was obtained from the outpatient pharmacy prescription database. Adjusted self‐matched odds ratios (OR) and their 95% confidence intervals (CI) were estimated with a conditional logistic regression model. Results A total of 4876 cirrhotic patients were included. The adjusted OR (95% CI) was 1.44 (0.89–2.31) for celecoxib, 1.87 (1.66–2.11) for oral non‐selective NSAIDs and 1.90 (1.55–2.32) for parenteral NSAIDs overall. Risks were similar for variceal and non‐variceal events. Concomitant use of proton pump inhibitors and histamine‐2 receptor antagonists tended to decrease the upper GI toxicity associated with non‐selective NSAIDs and celecoxib. Conclusion The use of nsNSAIDs but not celecoxib was associated with a two‐fold increased risk of variceal and non‐variceal upper GI events among cirrhotic patients.