title: Association of upper gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study.
abstract: OBJECTIVE
  To determine the profile of risk of upper gastrointestinal toxicity during continuous treatment with, and after cessation of, non-steroidal anti-inflammatory drugs.
  
  
  METHODS
  Cohort study with a prospectively constructed, population based, record linkage database containing details of exposure to all community dispensed non-steroidal anti-inflammatory drugs and also all admissions to hospital for upper gastrointestinal diagnoses.
  
  
  METHODS
  The population of Tayside, Scotland.
  
  
  METHODS
  52,293 subjects aged 50 and over who received one or more non-steroidal anti-inflammatory between 1 January 1989 and 31 December 1991 and 73,792 subjects who did not receive one during the same period (controls).
  
  
  METHODS
  Admission to hospital for upper gastrointestinal bleeding and perforation, and admission for other upper gastrointestinal diagnoses.
  
  
  RESULTS
  About 2% of the non-steroidal anti-inflammatory cohort were admitted with an upper gastrointestinal event during the study period compared with 1.4% of controls. The risk of admission for upper gastrointestinal haemorrhage and perforation was constant during continuous non-steroidal anti-inflammatory exposure and carried over after the end of exposure. The results were similar for admissions for all upper gastrointestinal events.
  
  
  CONCLUSIONS
  This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.
authors.affiliation: Department of Clinical Pharmacology, University of Dundee, Ninewells Hospital and Medical School.
authors.forename: T M
authors.initials: TM
authors.lastname: MacDonald
authors.forename: S V
authors.initials: SV
authors.lastname: Morant
authors.forename: G C
authors.initials: GC
authors.lastname: Robinson
authors.forename: M J
authors.initials: MJ
authors.lastname: Shield
authors.forename: M M
authors.initials: MM
authors.lastname: McGilchrist
authors.forename: F E
authors.initials: FE
authors.lastname: Murray
authors.forename: D G
authors.initials: DG
authors.lastname: McDevitt
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000188:drug therapy; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014945:Wound Healing
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal