Nonsteroidal antiinflammatory drugs and upper gastrointestinal hemorrhage – a prospective study (1994–2003)

• Published in: Endoskopie heute
• Main Authors: Skok, P, Skok, M
• Format: Conference Proceeding
• Language: German
• Published: 12.03.2004
• ISSN: 0933-811X; 1439-2577
• DOI: 10.1055/s-2004-820678

Introduction. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used over many decades for treatment of inflammation and pain. Due to prostaglandin inhibition this drugs cause clinically significant gastrointestinal adverse effects, manifested as ulcers, hemorrhages and perforation. Aims and Methods. To evaluate the problem of patients taking NSAIDs who developed upper gastrointestinal hemorrhage in a prospective study.Included were patients who were admitted to our institution between 1 January 1994 and 30 April 2003. Emergency endoscopy was performed in all patients. Results. 6024 patients were investigated: 2290 women (38%) and 3734 (62%) men (av. age 59.1 years, SD 17.2). In 5209 patients (86.4%) the source of bleeding was confirmed in the upper gastrointestinal tract. Among our patients 55% were aged over 60 years, 26.7% were older than 80 years. Sequelae of peptic ulcer disease were the most significant cause of upper gastrointestinal hemorrhage, in 48% (2500/5209). In the last week prior to bleeding, 20,5% of patients were taking regularly NSAIDs, corticosteroids, salycilates or anticoagulant therapy at least in single daily dose. The majority, 94%, were taking NSAIDs or salycilates, 8% of them both preparations at the same time. In the period 1994–1998 patients were taking among NSAIDs most often ketoprofen, diclofenac or naproxen, less often ibuprofen, nabumeton, etodolac or piroxicam. In the second period (1999–2003) most often were prescribed naproxen, diclofenac, ketoprofen, less often ibuprofen, etodolac and meloxicam. 77% of all patients were admitted to hospital due to hemorrhage which manifested at home, in 21.5% of patients hemorrhage manifested during hospital stay. Only a minority of patients were receiving gastroprotective therapy. No significant difference in mortality of patients who were taking NSAIDs, corticosteroids, salycilates or anticoagulants compared to those who did not, was found, p=0.10. Conclusions. Upper gastrointestinal hemorrhage is a serious complication of NSAIDs medication, particularly in older patients. Safe use of NSAIDs is based on careful selection of patients, correct intake of the prescribed drug and efficacious protection of patients with risk factors. In our society this drugs are prescribed too often.