title: Gastro-intestinal problems and concomitant medication in NSAID users: additional findings from a questionnaire-based survey in Italy.
abstract: BACKGROUND
  In a previous questionnaire-based survey, we found extensive use of nonsteroidal anti-inflammatory drugs (NSAIDs) in subjects with risk factors for serious gastrointestinal complications.
  
  
  OBJECTIVE
  This study focused on the use of NSAIDs in subjects who reported either (a) pre-existing disorders which would have required caution in using NSAIDs (e.g. dyspepsia/heartburn or peptic ulcer) or (b) co-medication with drugs having a high risk of interacting with NSAIDs.
  
  
  METHODS
  Between March and September 2002, 65 general practitioners (GPs) submitted a validated self-administered questionnaire on health status and drug use to 3,250 subjects (age >or=18 years, stratified by sex and age). The questionnaire was divided into three parts: (1) sociodemographic information, (2) symptoms/illnesses (in the previous 6 months) and (3) drugs taken during the previous week.
  
  
  RESULTS
  Of the 2,738 subjects who filled in the questionnaire (84% of responders), 633 (23%) used NSAIDs and, among them, 114 (18%) were chronic users. Among the subjects reporting dyspepsia/heartburn or ulcer (n=909 of 2,738), 24% were occasional NSAID users and 6% chronic users. Of the chronic NSAID users reporting gastrointestinal symptoms, 35% also used a drug for acid-related disorders, but only 14% used daily a proton pump inhibitor (PPI). One hundred six subjects used concomitantly more than one NSAID. Eighteen percent of the subjects using corticosteroids also reported NSAID use; similar proportions were seen in subjects using selective serotonin reuptake inhibitor (SSRI) antidepressants or calcium channel blockers, whereas 6% of the subjects with oral anticoagulants used NSAIDs.
  
  
  CONCLUSIONS
  Our study shows that NSAIDs are frequently used in patients with upper gastrointestinal complaints or in combination with potentially interacting medications. Adverse effects and untoward drug interactions should be monitored in patients treated with NSAIDs in order to minimise their occurrence.
authors.affiliation: Department of Pharmacology and Interuniversity Research Centre for Pharmacoepidemiology, University of Bologna, Bologna, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Silvani
authors.forename: Domenico
authors.initials: D
authors.lastname: Motola
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.forename: Ambrogio
authors.initials: A
authors.lastname: Bottoni
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Ponti
authors.forename: Alberto
authors.initials: A
authors.lastname: Vaccheri
authors.forename: Nicola
authors.initials: N
authors.lastname: Montanaro
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004415:Dyspepsia / Q000139:chemically induced; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006306:Health Surveys; D006356:Heartburn / Q000139:chemically induced; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D017367:Selective Serotonin Reuptake Inhibitors