title: Case-control study on the association of upper gastrointestinal bleeding and nonsteroidal anti-inflammatory drugs in Japan.
abstract: OBJECTIVE
  Studies in Western populations have shown the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and upper gastrointestinal bleeding (UGIB). The role of Helicobacter pylori infection in NSAIDs-related UGIB remains to be studied. We conducted a case-control study in Japan to investigate these related topics.
  
  
  METHODS
  Cases of UGIB due to duodenal or gastric ulcer, or gastritis were identified in 14 study hospitals in various areas of Japan. For each case, two controls were identified from population registries in the same district. Information on drugs and other risk factors was obtained from 175 cases and 347 controls by telephone interviews. Anti-H. pylori antibody in the urine was measured in a single laboratory for all the cases and 225 controls.
  
  
  RESULTS
  The odds ratio (OR) of UGIB was 5.5 for aspirin and 6.1 for other NSAIDs (NANSAIDs) (p<0.01). The OR for regular use was higher than for occasional use both for aspirin (7.7 vs 2.0) and NANSAIDs (7.3 vs 4.1). Loxoprofen (5.9), frequently used in Japan as a safe 'prodrug', was significantly associated with UGIB. The odds ratio for H. pylori infection was 4.9 and the relative excess risk due to the interaction between H. pylori and the use of NSAID was 1.2 (95% CI: -5.8-8.1).
  
  
  CONCLUSIONS
  NSAIDs including loxoprofen increase the risk of UGIB in Japan as in Western countries, with a similar magnitude of association. There was no evidence of biological interaction between NSAIDs and H. pylori infection.
authors.affiliation: Nippon Medical School, Tokyo, Japan.
authors.forename: Choitsu
authors.initials: C
authors.lastname: Sakamoto
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugano
authors.forename: Shinichi
authors.initials: S
authors.lastname: Ota
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sakaki
authors.forename: Shin'ichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Taku
authors.initials: T
authors.lastname: Tsukui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Osawa
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Junji
authors.initials: J
authors.lastname: Yoshino
authors.forename: Yuji
authors.initials: Y
authors.lastname: Mizokami
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mine
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Arakawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Kuwayama
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji
authors.forename: Koji
authors.initials: K
authors.lastname: Yakabi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Chiba
authors.forename: Tooru
authors.initials: T
authors.lastname: Shimosegawa
authors.forename: Jane E
authors.initials: JE
authors.lastname: Sheehan
authors.forename: Susana
authors.initials: S
authors.lastname: Perez-Gutthann
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: David W
authors.initials: DW
authors.lastname: Kaufman
authors.forename: Tsugumichi
authors.initials: T
authors.lastname: Sato
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kubota
authors.forename: Akira
authors.initials: A
authors.lastname: Terano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal