title: Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal (GI) bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding.
  
  
  METHODS
  We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months) and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day).
  
  
  RESULTS
  581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96) or for whichever other grouping of antidepressants.
  
  
  CONCLUSIONS
  The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.
authors.affiliation: Instituto de Farmacoepidemiología, Universidad de Valladolid, Valladolid, Spain. carvajal@ife.uva.es
authors.forename: Alfonso
authors.initials: A
authors.lastname: Carvajal
authors.forename: Sara
authors.initials: S
authors.lastname: Ortega
authors.forename: Lourdes
authors.initials: L
authors.lastname: Del Olmo
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.forename: Carmelo
authors.initials: C
authors.lastname: Aguirre
authors.forename: Borja
authors.initials: B
authors.lastname: Ruiz
authors.forename: Anita
authors.initials: A
authors.lastname: Conforti
authors.forename: Roberto
authors.initials: R
authors.lastname: Leone
authors.forename: Paula
authors.initials: P
authors.lastname: López-Vázquez
authors.forename: Adolfo
authors.initials: A
authors.lastname: Figueiras
authors.forename: Luisa
authors.initials: L
authors.lastname: Ibáñez
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology*; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology*; D013030:Spain; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors