title: Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Selective serotonin reuptake inhibitors (SSRIs) are used to treat various psychiatric disorders. However, there are concerns that SSRIs increase the risk for upper gastrointestinal bleeding (UGIB).
  
  
  METHODS
  We performed a systematic review and meta-analysis of controlled observational studies to determine whether SSRI use affects the risk for UGIB. Our analysis included all observational studies that compared UGIB development among patients receiving SSRIs vs no treatment. We calculated pooled odds ratios using random- and fixed-effects models.
  
  
  RESULTS
  A total of 22 studies (6 cohort and 16 case-control studies) involving more than 1,073,000 individuals were included in our meta-analysis. In comparing SSRI users with patients who had not taken SSRIs, the odds for developing UGIB were 1.55-fold higher (odds ratio, 1.55; 95% confidence interval, 1.35-1.78). In subgroup analyses, the association was greatest for patients who received concurrent therapy with nonsteroidal anti-inflammatory or antiplatelet drugs; we found no significant increase in the risk of developing UGIB among patients receiving concurrent acid-suppressing drugs.
  
  
  CONCLUSIONS
  SSRI use was associated with an almost 2-fold increase in the risk of developing UGIB, especially among patients at high risk for GI bleeding (concurrent use of nonsteroidal anti-inflammatory or antiplatelet drugs). This risk might be reduced significantly by concomitant use of acid-suppressing drugs.
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Hai-Yin
authors.initials: HY
authors.lastname: Jiang
authors.affiliation: Department of Infectious Diseases, Taizhou Hospital Affiliated to Wenzhou Medical College, Linhai, Zhejiang, China.
authors.forename: Hua-Zhong
authors.initials: HZ
authors.lastname: Chen
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Xin-Jun
authors.initials: XJ
authors.lastname: Hu
authors.affiliation: Department of Traditional Chinese Medicine, The Seventh People's Hospital of Hangzhou, Hangzhou, Zhejiang, China.
authors.forename: Zheng-He
authors.initials: ZH
authors.lastname: Yu
authors.affiliation: Department of Hematology, Integrated Chinese and Western Medicine Hospital of Zhejiang Province, Hangzhou, Zhejiang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Min
authors.initials: M
authors.lastname: Deng
authors.affiliation: Department of Traditional Chinese Medicine, The Seventh People's Hospital of Hangzhou, Hangzhou, Zhejiang, China. Electronic address: hz_yhzhang@hotmail.com.
authors.forename: Yong-Hua
authors.initials: YH
authors.lastname: Zhang
authors.affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: hzruanbing@gmail.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Ruan
mesh_terms: D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: 5HT; Antidepressant; Hemorrhage; Stomach