Prescription of nonsteroidal anti-inflammatory drugs and co-prescribed drugs for mucosal protection: analysis of the present status based on questionnaires obtained from orthopedists in Japan.
OBJECTIVE
Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events.


METHODS
We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name, pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs.


RESULTS
Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%).


CONCLUSIONS
Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics.
Tsumura
Hidetaka
H
Department of Gastroenterology, Kobe University School of Medicine.
Tamura
Isamu
I
Tanaka
Hiroshi
H
Chinzei
Ryo
R
Ishida
Tsukasa
T
Masuda
Atsuhiro
A
Shiomi
Hideyuki
H
Morita
Yoshinori
Y
Yoshida
Masaru
M
Kutsumi
Hiromu
H
Inokuchi
Hideto
H
Doita
Minoru
M
Kurosaka
Masahiro
M
Azuma
Takeshi
T
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D019538:Health Care Surveys; D006635:Histamine H2 Antagonists / Q000008:administration & dosage*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000188:drug therapy; D009985:Orthopedics / Q000592:standards / Q000639:trends; D010437:Peptic Ulcer / Q000139:chemically induced / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention / Q000379:methods; D054328:Proton Pump Inhibitors; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors