title: Drug use and upper gastrointestinal complications in children: a case-control study.
abstract: OBJECTIVE
  To evaluate the risk of upper gastrointestinal complications (UGIC) associated with drug use in the paediatric population.
  
  
  METHODS
  This study is part of a large Italian prospective multicentre study. The study population included children hospitalised for acute conditions through the emergency departments of eight clinical centres. Patients admitted for UGIC (defined as endoscopically confirmed gastroduodenal lesions or clinically defined haematemesis or melena) comprised the case series; children hospitalised for neurological disorders formed the control group. Information on drug and vaccine exposure was collected through parental interview during the children's hospitalisation. Logistic regression was used to estimate ORs for the occurrence of UGIC associated with drug use adjusted for age, clinical centre and concomitant use of any drug.
  
  
  RESULTS
  486 children hospitalised for UGIC and 1930 for neurological disorders were enrolled between November 1999 and November 2010. Drug use was higher in cases than in controls (73% vs 54%; p<0.001). UGICs were associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs) (adjusted OR 2.9, 95% CI 2.1 to 4.0), oral steroids (adjusted OR 2.9, 95% CI 1.7 to 4.8) and antibiotics (adjusted OR 2.3, 95% CI 1.8 to 3.1). The duration of use of these drug categories was short (range 1-8 days). Paracetamol showed a lower risk (adjusted OR 2.0, 95% CI 1.5 to 2.6) compared to ibuprofen (adjusted OR 3.7, 95% CI 2.3 to 5.9), although with partially overlapping CIs.
  
  
  CONCLUSIONS
  NSAIDs, oral steroids and antibiotics, even when administered for a short period, were associated with an increased risk of UGIC.
authors.affiliation: Regina Margherita Children’s Hospital, Turin, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bianciotto
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.forename: Irene
authors.initials: I
authors.lastname: Raffaldi
authors.forename: Clara
authors.initials: C
authors.lastname: Gabiano
authors.forename: Pier-Angelo
authors.initials: PA
authors.lastname: Tovo
authors.forename: Sara
authors.initials: S
authors.lastname: Sollai
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
authors.forename: Francesco
authors.initials: F
authors.lastname: Mannelli
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tipo
authors.forename: Roberto
authors.initials: R
authors.lastname: Da Cas
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Traversa
authors.forename: Francesca
authors.initials: F
authors.lastname: Menniti-Ippolito
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012306:Risk; D041742:Upper Gastrointestinal Tract / Q000473:pathology*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen