title: Under-utilization of gastroprotective drugs in patients with NSAID-related ulcers.
abstract: OBJECTIVE
  To determine the proportion of patients with a risk of NSAID gastropathy receiving adequate gastroprotection.
  
  
  METHODS
  This observational study was performed between November 2001 and December 2003. We selected patients who were hospitalized with perforated and bleeding gastroduodenal ulcers attributable to NSAID use and controls without ulcers. Data were collected on their sociodemographic characteristics, actual and recent medication, comorbidity and medical history. For each patient and control the number of different risk factors associated with NSAID gastropathy was calculated. A composite risk factor (CRF) was obtained from the sum of all separate risk factors.
  
  
  RESULTS
  During the observational period a total of 388 patients using NSAID were included in the study, 104 patient cases and 284 matched community-based controls. The mean CRF was significantly higher in patient cases than in controls (cases mean CRF 3.31 (SD 1.67) and controls mean CRF 2.76 (SD 1.45), p = 0.002). A total of 148 (38%) patients used an adequate preventive strategy. Significant variables for using a preventive strategy were concomitant use of steroids (corrected odds ratio 4.22, 95% CI 2.11 8.47, p < 0.001), a history of gastroduodenal ulcers (corrected odds ratio 2.90, 95% CI 1.51 - 5.56, p = 0.001) and concomitant use of low-dose aspirin (corrected odds ratio 1.96,95% CI 1.18 3.25, p= 0.01). Among patients with 4 or more risk factors associated with NSAID gastropathy, 47% still did not use adequate gastroprotection.
  
  
  CONCLUSIONS
  Gastroprotective drugs are greatly under-utilized in patients with a risk of NSAID gastropathy.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente Hospital and University of Twente, 2Stroinkslanden Pharmacy, Enschede, The Netherlands. H.Vonkeman@ziekenhuis-mst.nl
authors.forename: H E
authors.initials: HE
authors.lastname: Vonkeman
authors.forename: R W
authors.initials: RW
authors.lastname: Fernandes
authors.forename: M A F J
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001241:Aspirin; D004363:Drug Utilization; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D005938:Glucocorticoids; D001241:Aspirin