title: Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children.
abstract: OBJECTIVE
  To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug (NSAIDs) use in children.
  
  
  METHODS
  A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber (physician or self-medication) were examined.
  
  
  RESULTS
  Fifty-one patients, including 34 males, were enrolled (median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients (68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients (56.9%)]. Seven patients had positive family history of Helicobacter pylori (H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four (47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom (33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51 (62%) patients, duodenal lesions in 17 (33%) and esophageal lesions in 8 (15%). In 10/51 (19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight (94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51 (6%) patients, an endoscopic hemostasis was needed.
  
  
  CONCLUSIONS
  The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in children.
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Sabrina
authors: S
authors: Cardile
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Massimo
authors: M
authors: Martinelli
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Arrigo
authors: A
authors: Barabino
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Paolo
authors: P
authors: Gandullia
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Salvatore
authors: S
authors: Oliva
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Giovanni
authors: G
authors: Di Nardo
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Luigi
authors: L
authors: Dall'Oglio
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Francesca
authors: F
authors: Rea
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Gian Luigi
authors: GL
authors: de'Angelis
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Barbara
authors: B
authors: Bizzarri
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Graziella
authors: G
authors: Guariso
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Enzo
authors: E
authors: Masci
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Annamaria
authors: A
authors: Staiano
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Erasmo
authors: E
authors: Miele
authors: Sabrina Cardile, Claudio Romano, Gastroenterology and Endoscopic Unit, Department of Pediatrics, University of Messina, 98100 Messina, Italy.
authors: Claudio
authors: C
authors: Romano
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Gastrointestinal bleeding; Hematemesis; Melena; Non-steroidal anti-inflammatory drug; Pediatrics