Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet ; : — Nonsteroidal anti-inflammatory drugs and upper gastrointestinal bleeding, identifying high-risk groups by excess risk estimates.
Scand J Gastroenterol ; 30 : — Matikaienen M, Kangas E. Is there a relationship between the use of analgesics and non-steroidal anti-inflammatory drugs and acute upper gastrointestinal bleeding? A Finnish case-control prospective study. Individual nonsteroidal antiinflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation. Epidemiology ; 8 : 18 — Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs.
Arch Intern Med ; : 33 —9. Singh G, Triadafilopoulos G. J Rheumatol ; 26 : 18 — Br J Clin Pharmacol ; 45 : — Validation of information recorded on general practitioner based computerised data resource in the United Kingdom.
BMJ ; : —8. Steroids and peptic ulcer. N Engl J Med ; : —3. Association of adrenocorticosteroid therapy and peptic- ulcer disease. N Engl J Med ; : 21 —4. Conn H, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med ; : — Oxford University Press is a department of the University of Oxford.
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Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Steroids and Risk of Upper Gastrointestinal Complications. Oxford Academic. Google Scholar. Select Format Select format. Permissions Icon Permissions. Abstract Most antiinflammatory drugs have been associated with an increase in upper gastrointestinal complications. TABLE 1. Tseng C-L et al. Short-term use of glucocorticoids and risk of peptic ulcer bleeding: A nationwide population-based case-crossover study.
Aliment Pharmacol Ther Jun 22; [e-pub]. Aliment Pharmacol Ther Jun 22 In a large retrospective study, short-term exposure increased bleeding risk. Comment This large, retrospective study was designed to control for unknown confounding factors. Citation s : Tseng C-L et al. Disclosures Disclosures for David J. Patients were subjected to upper GI endoscopy for screening, or investigation of abdominal symptoms or anemia. A gastric or duodenal ulcer was considered to be a peptic ulcer.
Bleeding from a peptic ulcer was restricted to a spurting vessel, an oozing vessel, a visible vessel or a clot, according to the Forrest classification system Table II shows the diagnosis of patients with peptic ulcer bleeding. Seventeen and two patients were diagnosed with bleeding from gastric and duodenal ulcers, respectively.
The Wald test was applied to analyze the statistical significance of the correlation of peptic ulcer bleeding and medication Chi-square tests were applied to analyze the correlation between peptic ulcer bleeding and administration of PPIs or H2RAs. JMP Table III shows the characteristics of patients with bleeding from peptic ulcers. The patients had been subjected to monotreatment with NSAIDs, immunosuppressive agents or corticosteroid, but not their combination.
Four patients were subjected to the urea breath test, one of which was positive and had a history of peptic ulcer. To calculate the odds ratios for various medication types with regard to peptic ulcer bleeding, logistic regression analysis was used Table IV. The odds ratio of immunosuppressive agents was 5. It was found that among the different medications, immunosuppressive agents had the strongest correlation with peptic ulcer bleeding. Logistic regression analysis of the relationship between medication and bleeding from peptic ulcers.
To confirm the association between immunosuppressive agents and peptic ulcer bleeding, the Wald test was applied Table V. Case reports and case series have documented the use of immunosuppressive agents to treat patients with peptic ulcers 24 — However, studies assessing the possible association between the administration of immunosuppressive agents and peptic ulcer bleeding are currently lacking.
To answer this question, the present case findings provided novel evidence that immunosuppressive agent use is significantly correlated with peptic ulcer bleeding. Although the mechanisms by which immunosuppressive agent use may be correlated with peptic ulcer bleeding is elusive, it is possible that these agents cause bleeding by inhibiting ulcer healing The results of the present study are clinically important, as they are relevant to ensuring patient safety, with peptic ulcer bleeding being one reason for the discontinuation of immunosuppressive agents Further studies with additional patients are therefore warranted to confirm these results.
In previous studies, NSAIDs and corticosteroids were rated to not pose any risk for peptic ulcer bleeding 28 , The results of the present study are therefore consistent with those of previous ones. One reason is that in the present study, the number of patients treated with NSAIDs and corticosteroids was relatively small. Peptic ulcer bleeding is still fatal in certain patients, such as the elderly PPIs are effective for reducing peptic ulcer bleeding In the present study, PPIs significantly lowered the risk of peptic ulcer bleeding.
Therefore, the results of the present study were consistent with those of previous ones. Likewise, PPIs may lower the risk of peptic ulcer bleeding associated with immunosuppressive agents. However, PPIs represent a risk factor for bleeding from the small intestine, hip fracture and cardiac events 34 , It is therefore recommended that long-term use of PPIs is avoided With this regard, H2RAs may be recommended for long-term administration to prevent peptic ulcer bleeding.
A major limitation is that the present study was based on a relatively small number of patients. In future studies, a larger number of patients should be enrolled and studied. In conclusion, the present study revealed that immunosuppressive agents were correlated with peptic ulcer bleeding.
Any increased incidence of peptic ulceration seen in patients on long-term therapy of this type is probably best explained on the basis of a progressive increase in mucosal susceptibility to ulceration caused by factors as yet not completely determined. This is a preview of subscription content, access via your institution.
Rent this article via DeepDyve. Boland, E. Prednisone and prednisolone therapy in rheumatoid arthritis: Clinical evaluation based on continuous observation for periods of six to nine months. JAMA : , Google Scholar. Kammerer, W. Peptic ulcer in rheumatoid patients on corticosteroid therapy: A clinical, experimental, and radiologic study. Arthritis Rheum 1 , West, H. Prevention of peptic ulceration during corticosteroid therapy.
Brit Med J 2 , Goodman, L. The Pharmacological Basis of Therapeutics , ed. Macmillan, New York, , p.
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