Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs.
OBJECTIVE
To estimate the relative risk for peptic ulcer disease that is associated with the use of oral corticosteroids.


METHODS
A nested case-control study.


METHODS
Tennessee Medicaid program.


METHODS
The case patients (n = 1415) were hospitalized between 1984 and 1986 for gastric or duodenal ulcer or for upper gastrointestinal hemorrhage of unknown cause. The controls (n = 7063) were randomly selected from Medicaid enrollees not meeting the study criteria for inclusion as case patients.


RESULTS
The estimated relative risk for the development of peptic ulcer disease among current users of oral corticosteroids was 2.0 (95% CI, 1.3 to 3.0). However, the risk was increased only in those who concurrently received nonsteroidal anti-inflammatory drugs (NSAIDs); these persons had an estimated relative risk associated with current corticosteroid use of 4.4 (CI, 2.0 to 9.7). In contrast, the estimated relative risk for those corticosteroid users not receiving NSAIDs was 1.1 (CI, 0.5 to 2.1). Persons concurrently receiving corticosteroids and NSAIDs had a risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug.


CONCLUSIONS
Discrepant findings among earlier studies regarding steroids and the risk for peptic ulcer disease could in part be due to differences in the use of NSAIDs among study participants. The high risk for peptic ulcer disease associated with combined use of NSAIDs and corticosteroids indicates the need to prescribe this drug combination cautiously.
Piper
J M
JM
Vanderbilt University School of Medicine, Nashville, Tennessee.
Ray
W A
WA
Daugherty
J R
JR
Griffin
M R
MR
D000284:Administration, Oral; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D004347:Drug Interactions; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids