Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs
Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications. We compared previous use of NSAIDs in 1144 patients aged 60 and older admi...
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Published in | The Lancet (British edition) Vol. 343; no. 8905; pp. 1075 - 1078 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
London
Elsevier Ltd
30.04.1994
Lancet Elsevier Limited |
Subjects | |
Online Access | Get full text |
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Abstract | Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications. We compared previous use of NSAIDs in 1144 patients aged 60 and older admitted to hospitals in five large cities with peptic ulcer bleeding and in 1126 hospital controls and 989 community controls matched for age and sex. Peptic ulcer bleeding was strongly associated with use of non-aspirin NSAIDs of any type during the 3 months before admission (411 cases, 351 controls; odds ratio 4 5 [95% Cl 3·6 to 5·6]). The odds ratios for peptic ulcer bleeding were lowest for ibuprofen (2·0 [1·4-2 8]) and diclofenac (4 2 [2·6-6 8]), and intermediate for indomethacin, naproxen, and piroxicam (11·3 [6 3-20·3], 9 1 [5·5-15·1], and 13·7 [7·1-26·3]). Azapropazone and ketoprofen carried the highest risks (31·5 [10 3-96 9] and 23 7 [7·6-74 2]). Risks also increased with drug dose (low dose 2·5 [1·7-3·8], intermediate 4·5 [3·3-6 0], and high 8·6 [5·8-12 6]) for all drugs combined. Appropriate clinical strategies could prevent many episodes of peptic ulcer bleeding: NSAIDs should be used only in patients who do not respond to other analgesics; the lowest possible doses should be used; and the least toxic NSAIDs should be selected. |
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AbstractList | Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications. We compared previous use of NSAIDs in 1144 patients aged 60 and older admitted to hospitals in five large cities with peptic ulcer bleeding and in 1126 hospital controls and 989 community controls matched for age and sex. Peptic ulcer bleeding was strongly associated with use of non-aspirin NSAIDs of any type during the 3 months before admission (411 cases, 351 controls; odds ratio 4.5 [95% CI 3.6 to 5.6]). The odds ratios for peptic ulcer bleeding were lowest for ibuprofen (2.0 [1.4-2.8]) and diclofenac (4.2 [2.6-6.8]), and intermediate for indomethacin, naproxen, and piroxicam (11.3 [6.3-20.3], 9.1 [5.5-15.1], and 13.7 [7.1-26.3]). Azapropazone and ketoprofen carried the highest risks (31.5 [10.3-96.9] and 23.7 [7.6-74.2]). Risks also increased with drug dose (low dose 2.5 [1.7-3.8], intermediate 4.5 [3.3-6.0], and high 8.6 [5.8-12.6]) for all drugs combined. Appropriate clinical strategies could prevent many episodes of peptic ulcer bleeding: NSAIDs should be used only in patients who do not respond to other analgesics; the lowest possible doses should be used; and the least toxic NSAIDs should be selected. Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether some drugs are more likely than others to cause such complications. We compared previous use of NSAIDs in 1144 patients aged 60 and older admitted to hospitals in five large cities with peptic ulcer bleeding and in 1126 hospital controls and 989 community controls matched for age and sex. Peptic ulcer bleeding was strongly associated with use of non-aspirin NSAIDs of any type during the 3 months before admission (411 cases, 351 controls; odds ratio 4 5 [95% Cl 3·6 to 5·6]). The odds ratios for peptic ulcer bleeding were lowest for ibuprofen (2·0 [1·4-2 8]) and diclofenac (4 2 [2·6-6 8]), and intermediate for indomethacin, naproxen, and piroxicam (11·3 [6 3-20·3], 9 1 [5·5-15·1], and 13·7 [7·1-26·3]). Azapropazone and ketoprofen carried the highest risks (31·5 [10 3-96 9] and 23 7 [7·6-74 2]). Risks also increased with drug dose (low dose 2·5 [1·7-3·8], intermediate 4·5 [3·3-6 0], and high 8·6 [5·8-12 6]) for all drugs combined. Appropriate clinical strategies could prevent many episodes of peptic ulcer bleeding: NSAIDs should be used only in patients who do not respond to other analgesics; the lowest possible doses should be used; and the least toxic NSAIDs should be selected. |
Author | Rawlins, M.D. Wainwright, P. Weil, J. Langman, M.J.S. Lawson, D.H. Logan, R.F.A. Vessey, M.P. Colin-Jones, D.G. Murphy, M. |
Author_xml | – sequence: 1 givenname: M.J.S. surname: Langman fullname: Langman, M.J.S. organization: University of Birmingham , United Kingdom – sequence: 2 givenname: J. surname: Weil fullname: Weil, J. organization: University of Birmingham , United Kingdom – sequence: 3 givenname: P. surname: Wainwright fullname: Wainwright, P. organization: University of Birmingham , United Kingdom – sequence: 4 givenname: D.H. surname: Lawson fullname: Lawson, D.H. organization: Glasgow Royal Infirmary , United Kingdom – sequence: 5 givenname: M.D. surname: Rawlins fullname: Rawlins, M.D. organization: University of Newcastle upon Tyne , United Kingdom – sequence: 6 givenname: R.F.A. surname: Logan fullname: Logan, R.F.A. organization: University of Nottingham , United Kingdom – sequence: 7 givenname: M. surname: Murphy fullname: Murphy, M. organization: University of Oxford , United Kingdom – sequence: 8 givenname: M.P. surname: Vessey fullname: Vessey, M.P. organization: University of Oxford , United Kingdom – sequence: 9 givenname: D.G. surname: Colin-Jones fullname: Colin-Jones, D.G. organization: Queen Alexandra Hospital, Portsmouth, UK |
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References | Somerville, Faulkner, Langman (BIB7) 1992; 4 Garcia Rodriguez, Jick (BIB16) 1994; 343 Rossi, Hsu, Faich (BIB6) 1987; 294 Holvoet, Terriere, Van Hee, Verbist, Fierens, Hautekeete (BIB10) 1991; 32 Griffin, Piper, Daugherty, Snowden, Ray (BIB2) 1991; 114 Kaufman, Kelly, Sheehan (BIB11) 1993; 53 CSM Update 1 (BIB5) 1985; 292 Savage, Moller, Ballantyne, Wells (BIB12) 1993; 36 Henry, Dobson, Turner (BIB15) 1993; 105 Garcia Rodriguez, Walker, Perez Gutthann (BIB13) 1992; 3 Nobili, Mosconi, Franzosi, Tognoni (BIB14) 1992; 1 Carson, Strom, Soper, West, Morse (BIB3) 1987; 146 Somerville, Faulkner, Langman (BIB1) 1986; i Beard, Walker, Perera, Jick (BIB9) 1987; 147 Carson, Strom, Morse (BIB8) 1987; 147 Laporte, Came, Vidal, Morena, Juan (BIB4) 1991; 337 7912318 - Lancet. 1994 Jul 2;344(8914):56-7 Lancet 1994 May 21;343(8908):1302 7909094 - Lancet. 1994 Apr 30;343(8905):1051-2 Beard (10.1016/S0140-6736(94)90185-6_BIB9) 1987; 147 Carson (10.1016/S0140-6736(94)90185-6_BIB3) 1987; 146 Laporte (10.1016/S0140-6736(94)90185-6_BIB4) 1991; 337 Carson (10.1016/S0140-6736(94)90185-6_BIB8) 1987; 147 Griffin (10.1016/S0140-6736(94)90185-6_BIB2) 1991; 114 Kaufman (10.1016/S0140-6736(94)90185-6_BIB11) 1993; 53 Somerville (10.1016/S0140-6736(94)90185-6_BIB1) 1986; i Rossi (10.1016/S0140-6736(94)90185-6_BIB6) 1987; 294 CSM Update 1 (10.1016/S0140-6736(94)90185-6_BIB5) 1985; 292 Nobili (10.1016/S0140-6736(94)90185-6_BIB14) 1992; 1 Garcia Rodriguez (10.1016/S0140-6736(94)90185-6_BIB13) 1992; 3 Somerville (10.1016/S0140-6736(94)90185-6_BIB7) 1992; 4 Garcia Rodriguez (10.1016/S0140-6736(94)90185-6_BIB16) 1994; 343 Henry (10.1016/S0140-6736(94)90185-6_BIB15) 1993; 105 Holvoet (10.1016/S0140-6736(94)90185-6_BIB10) 1991; 32 Savage (10.1016/S0140-6736(94)90185-6_BIB12) 1993; 36 |
References_xml | – volume: 3 start-page: 337 year: 1992 end-page: 342 ident: BIB13 article-title: Non-steroidal anti-inflammatory drugs and gastrointestinal hospitalizations in Saskatchewan: a cohort study publication-title: Epidemiology contributor: fullname: Perez Gutthann – volume: 114 start-page: 257 year: 1991 end-page: 263 ident: BIB2 article-title: Non-steroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons publication-title: Ann Intern Med contributor: fullname: Ray – volume: 147 start-page: 1054 year: 1987 end-page: 1059 ident: BIB8 article-title: The relative gastrointestinal toxicity of the non-steroidal anti-inflammatory drugs publication-title: Arch Intern Med contributor: fullname: Morse – volume: 147 start-page: 1621 year: 1987 end-page: 1623 ident: BIB9 article-title: Non-steroidal anti-inflammatory drugs and hospitalization for gastrointestinal bleeding in the elderly publication-title: Arch Intern Med contributor: fullname: Jick – volume: 294 start-page: 147 year: 1987 end-page: 150 ident: BIB6 article-title: Ulcerogenicity of piroxicam: an analysis of spontaneously reported data publication-title: BMJ contributor: fullname: Faich – volume: 36 start-page: 84 year: 1993 end-page: 90 ident: BIB12 article-title: Variation in the risk of peptic ulcer complications with non steroidal anti-inflammatory drug therapy publication-title: Arthritis Rheum contributor: fullname: Wells – volume: 1 start-page: 65 year: 1992 end-page: 72 ident: BIB14 article-title: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, a postmarketing surveillance case-control study publication-title: Pharmacoepidemiol Drug Safety contributor: fullname: Tognoni – volume: 292 start-page: 614 year: 1985 ident: BIB5 article-title: Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions publication-title: BMJ contributor: fullname: CSM Update 1 – volume: 146 start-page: 85 year: 1987 end-page: 88 ident: BIB3 article-title: The association of non-steroidal anti-inflammatory drugs with upper gastrointestinal tract bleeding publication-title: Arch Intern Med contributor: fullname: Morse – volume: 32 start-page: 730 year: 1991 end-page: 734 ident: BIB10 article-title: Relation of upper gastrointestinal bleeding to non steroidal anti-inflammatory drugs and aspirin: a case-control study publication-title: Gut contributor: fullname: Hautekeete – volume: 4 start-page: 645 year: 1992 end-page: 649 ident: BIB7 article-title: Risk factors for non-steroidal anti-inflammatory drug-associated upper gastrointestinal bleeding publication-title: Eur J Gastroenterol Hepatol contributor: fullname: Langman – volume: 53 start-page: 485 year: 1993 end-page: 494 ident: BIB11 article-title: Non-steroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding publication-title: Clin Pharmacol Ther contributor: fullname: Sheehan – volume: 337 start-page: 85 year: 1991 end-page: 89 ident: BIB4 article-title: Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs publication-title: Lancet contributor: fullname: Juan – volume: 343 start-page: 769 year: 1994 end-page: 772 ident: BIB16 article-title: Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs publication-title: Lancet contributor: fullname: Jick – volume: i start-page: 452 year: 1986 end-page: 454 ident: BIB1 article-title: Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer publication-title: Lancet contributor: fullname: Langman – volume: 105 start-page: 1978 year: 1993 end-page: 1988 ident: BIB15 article-title: Variability in the risk of major gastroinestinal complications from non aspirin non steroidal anti-inflammatory drugs publication-title: Gastroenterology contributor: fullname: Turner – volume: 114 start-page: 257 year: 1991 ident: 10.1016/S0140-6736(94)90185-6_BIB2 article-title: Non-steroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons publication-title: Ann Intern Med doi: 10.7326/0003-4819-114-4-257 contributor: fullname: Griffin – volume: 4 start-page: 645 year: 1992 ident: 10.1016/S0140-6736(94)90185-6_BIB7 article-title: Risk factors for non-steroidal anti-inflammatory drug-associated upper gastrointestinal bleeding publication-title: Eur J Gastroenterol Hepatol contributor: fullname: Somerville – volume: 146 start-page: 85 year: 1987 ident: 10.1016/S0140-6736(94)90185-6_BIB3 article-title: The association of non-steroidal anti-inflammatory drugs with upper gastrointestinal tract bleeding publication-title: Arch Intern Med doi: 10.1001/archinte.1987.00370010087021 contributor: fullname: Carson – volume: 36 start-page: 84 year: 1993 ident: 10.1016/S0140-6736(94)90185-6_BIB12 article-title: Variation in the risk of peptic ulcer complications with non steroidal anti-inflammatory drug therapy publication-title: Arthritis Rheum doi: 10.1002/art.1780360114 contributor: fullname: Savage – volume: 294 start-page: 147 year: 1987 ident: 10.1016/S0140-6736(94)90185-6_BIB6 article-title: Ulcerogenicity of piroxicam: an analysis of spontaneously reported data publication-title: BMJ doi: 10.1136/bmj.294.6565.147 contributor: fullname: Rossi – volume: 53 start-page: 485 year: 1993 ident: 10.1016/S0140-6736(94)90185-6_BIB11 article-title: Non-steroidal anti-inflammatory drug use in relation to major upper gastrointestinal bleeding publication-title: Clin Pharmacol Ther doi: 10.1038/clpt.1993.55 contributor: fullname: Kaufman – volume: 147 start-page: 1054 year: 1987 ident: 10.1016/S0140-6736(94)90185-6_BIB8 article-title: The relative gastrointestinal toxicity of the non-steroidal anti-inflammatory drugs publication-title: Arch Intern Med doi: 10.1001/archinte.1987.00370060050010 contributor: fullname: Carson – volume: i start-page: 452 year: 1986 ident: 10.1016/S0140-6736(94)90185-6_BIB1 article-title: Non-steroidal anti-inflammatory drugs and bleeding peptic ulcer publication-title: Lancet contributor: fullname: Somerville – volume: 147 start-page: 1621 year: 1987 ident: 10.1016/S0140-6736(94)90185-6_BIB9 article-title: Non-steroidal anti-inflammatory drugs and hospitalization for gastrointestinal bleeding in the elderly publication-title: Arch Intern Med doi: 10.1001/archinte.1987.00370090097017 contributor: fullname: Beard – volume: 343 start-page: 769 year: 1994 ident: 10.1016/S0140-6736(94)90185-6_BIB16 article-title: Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs publication-title: Lancet doi: 10.1016/S0140-6736(94)91843-0 contributor: fullname: Garcia Rodriguez – volume: 337 start-page: 85 year: 1991 ident: 10.1016/S0140-6736(94)90185-6_BIB4 article-title: Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs publication-title: Lancet doi: 10.1016/0140-6736(91)90744-A contributor: fullname: Laporte – volume: 1 start-page: 65 year: 1992 ident: 10.1016/S0140-6736(94)90185-6_BIB14 article-title: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, a postmarketing surveillance case-control study publication-title: Pharmacoepidemiol Drug Safety doi: 10.1002/pds.2630010204 contributor: fullname: Nobili – volume: 292 start-page: 614 year: 1985 ident: 10.1016/S0140-6736(94)90185-6_BIB5 article-title: Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions publication-title: BMJ contributor: fullname: CSM Update 1 – volume: 32 start-page: 730 year: 1991 ident: 10.1016/S0140-6736(94)90185-6_BIB10 article-title: Relation of upper gastrointestinal bleeding to non steroidal anti-inflammatory drugs and aspirin: a case-control study publication-title: Gut doi: 10.1136/gut.32.7.730 contributor: fullname: Holvoet – volume: 3 start-page: 337 year: 1992 ident: 10.1016/S0140-6736(94)90185-6_BIB13 article-title: Non-steroidal anti-inflammatory drugs and gastrointestinal hospitalizations in Saskatchewan: a cohort study publication-title: Epidemiology doi: 10.1097/00001648-199207000-00008 contributor: fullname: Garcia Rodriguez – volume: 105 start-page: 1978 year: 1993 ident: 10.1016/S0140-6736(94)90185-6_BIB15 article-title: Variability in the risk of major gastroinestinal complications from non aspirin non steroidal anti-inflammatory drugs publication-title: Gastroenterology doi: 10.1016/0016-5085(93)90952-9 contributor: fullname: Henry |
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Snippet | Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of peptic ulcer complications, but it is not clear whether... |
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SubjectTerms | Aged Aged, 80 and over Analgesics Anti-inflammatory agents Anti-Inflammatory Agents, Non-Steroidal - administration & dosage Anti-Inflammatory Agents, Non-Steroidal - adverse effects Aspirin Biological and medical sciences Bleeding Case-Control Studies Diclofenac Digestive system Drug dosages Female Health risk assessment Hospitalization Humans Ibuprofen Indomethacin Inflammation Intestine, Small - drug effects Ketoprofen Male Medical research Medical sciences Middle Aged Naproxen Nonsteroidal anti-inflammatory drugs Odds Ratio Patients Peptic Ulcer Hemorrhage - chemically induced Peptic Ulcer Hemorrhage - epidemiology Peptic Ulcer Perforation - chemically induced Peptic Ulcer Perforation - epidemiology Pharmacology. Drug treatments Piroxicam Risk Factors Side effects Ulcers |
Title | Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs |
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