title: Association between adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs and the incidence of gastric mucosal lesions in Japanese patients.
abstract: OBJECTIVE
  Recently, guidelines for the treatment and prevention of ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) were established. This study investigated the association between the current adherence to the guidelines and the incidence of gastric mucosal lesions caused by NSAIDs.
  
  
  METHODS
  This study included 254 NSAIDs users (128 regular and 126 on-demand users) who had undergone upper gastrointestinal endoscopy. The patients were characterized as high risk based on the following: age 65 years or older, history of peptic ulcers, concurrent use of corticosteroids or anticoagulants, and high-dose NSAIDs use. Adherence was defined as the prescription of NSAIDs with proton pump inhibitors, prostaglandin analogues, or high-dose histamine 2 receptor antagonists in high-risk NSAIDs user. The severity of gastric mucosal lesions was evaluated using the modified LANZA score (MLS).
  
  
  RESULTS
  Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of the on-demand NSAIDs users met our definition of high-risk patients. Adherence in the regular NSAIDs users and on-demand NSAIDs users was 25 (31.7%) and 16 (24.6%), respectively. The incidence of gastric mucosal lesions (MLS ≧ 1) was significantly higher in the nonadherence group than in the adherence group for both regular NSAIDs users (59.3 vs. 28.0%, P = 0.01) and on-demand NSAIDs users (63.3 vs. 25.0%, P = 0.01). Gastric ulcers in the regular NSAIDs users were more frequently observed in the nonadherence group than in the adherence group (29.6 vs. 4.0%, P < 0.01).
  
  
  CONCLUSIONS
  Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.
authors.affiliation: Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Tsumura
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Fujita
authors.forename: Isamu
authors.initials: I
authors.lastname: Tamura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Masaru
authors.initials: M
authors.lastname: Yoshida
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Mukai
authors.forename: Hideto
authors.initials: H
authors.lastname: Inokuchi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kutsumi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects / Q000473:pathology; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal