Complications of nonsteroidal antiiflammatory drug gastropathy and use of gastric cytoprotection: experience at a tertiary care health center.
OBJECTIVE
To determine what proportion of patients admitted to an academic medical center with complications of nonsteroidal antiinflammatory drug (NSAID) gastropathy had true indications for NSAID use, and whether patients with risk factors for NSAID gastropathy were receiving appropriate cytoprotection.


METHODS
A retrospective chart review was carried out of all patients admitted with upper gastrointestinal (GI) bleeding, ulcer perforation, or gastric outlet obstruction during 1990-91 and 1995-96. NSAID or acetylsalicylic acid (ASA) use and medical indications were determined. Risk factors for NSAID gastropathy were documented and included concomitant steroid use, history of peptic ulcer disease or GI bleeding, history of cardiovascular disease, age > 60 years, and use of more than one NSAID. GI medication coprescription for patients with risk factors for gastropathy was evaluated.


RESULTS
A total of 296 cases were identified. Use of NSAID was a contributing factor in 24% of patients admitted with upper GI bleeding, ulcer perforation, or gastric outlet obstruction. Use of ASA was a contributing factor in 25%. A true indication for NSAID/ASA use was identified in only 55% of cases. Fifty-nine patients had a single risk factor for NSAID gastropathy. Of these, 24% were receiving a coprescription for any GI medication at the time of admission to hospital and 8% were receiving misoprostol. In the 64 patients with 2 or more risk factors for NSAID gastropathy, 23% were concurrently receiving and GI medication and 2% were receiving misoprostol. In the 46 patients identified with a history of peptic ulcer disease or GI bleeding 28% were coprescribed a GI medication and 2% were taking misoprostol. There were no significant differences in the proportion of patients in any of the high risk groups who were receiving GI medications between 1990-91 and 1995-96.


CONCLUSIONS
Inappropriate use of NSAID/ASA and failure to adequately cytoprotect patients at risk of NSAID gastropathy may account for a significant proportion of patients who develop life threatening complications.
Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
V S
VS
Bakowsky
J G
JG
Hanly
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000627:therapeutic use*; D020011:Protective Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D020011:Protective Agents; D016595:Misoprostol