title: Nonsteroidal antiinflammatory drugs are associated with both upper and lower gastrointestinal bleeding.
abstract: To evaluate the association between nonsteroidal antiinflammatory drug (NSAID) use and upper gastrointestinal bleeding (UGIB) and lower gastrointestinal bleeding (LGIB), we performed a prospective case-control study at a large inner-city hospital over a 28-month period evaluating 461 consecutive patients hospitalized for UGIB and 105 with LGIB. During the same period, 1895 in-patients evaluated by our gastroenterology consultative service served as controls. At the time of initial evaluation, all patients were asked about the use of any prescription or over-the-counter NSAID product within one week of admission. Endoscopic examination was performed in most patients with bleeding. NSAID use was almost equivalent in patients with UGIB and LGIB (60%) and significantly greater than controls [34%; P < 0.001; odds ratio (OR) 3.0; 95% CI, 2.4-3.6]. The age, race, and gender adjusted risk for LGIB associated with NSAID use was significant [adjusted OR (AOR) 2.6; 95% CI 1.7-3.9], although less than UGIB (AOR 3.2; P = 0.34). The risk associated with diverticular bleeding (N = 53, AOR 3.4; 95% CI 1.9-6.2) was higher than duodenal ulcer bleeding although not significantly (N = 97, AOR 3.0). We conclude that NSAID use is strongly associated with LGIB and from lesions not considered associated with mucosal ulceration such as diverticulosis.
authors.affiliation: Department of Medicine, Emory University School of Medicine, Medical Service, Grady Memorial Hospital, Atlanta, Georgia, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Wilcox
authors.forename: L N
authors.initials: LN
authors.lastname: Alexander
authors.forename: G A
authors.initials: GA
authors.lastname: Cotsonis
authors.forename: W S
authors.initials: WS
authors.lastname: Clark
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000009:adverse effects; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004366:Nonprescription Drugs