Dyspepsia in non-steroidal anti-inflammatory drug users and the effect of preventive measures

To evaluate regular non-steroidal anti-inflammatory drug (NSAID) users for dyspepsia, as well as to assess the effect of preventive measures, and the reasons for non-adherence to gastroprotective agents (GPA) from a real-world perspective.

A prospective longitudinal study was conducted among outpatients with regular NSAID usage. The presence of dyspepsia was assessed by locally validated versions of the Leeds dyspepsia questionnaire (LDQ), GPA and the participants' adherence to the drugs were assessed at recruitment and 2 weeks later. GPA was defined as the use of antisecretory medications or cyclooxygenase-2 inhibitors.

Initially, 409 participants (mean age 52.3 ± 14.6 years, 60.6% females, 48.4% treated for musculoskeletal pain) were recruited. At recruitment, 50.9% of the participants had at least one upper gastrointestinal symptom. Complete data for follow-up analysis were collected from 158 participants who were naive NSAID users, had no prior gastrointestinal medication and who could be contacted. At 2-week follow-up there was no significant difference in the LDQ score change between NSAID users treated with GPA and those did not. However, there was a greater reduction in abdominal pain/discomfort (8.8% vs 5.0%, P < 0.001) and burping (8.8% vs 4.0%, P < 0.001) among participants using GPA compared with those who were not. Adherence to GPA was poor, with study participants citing the absence of gastrointestinal symptoms as their main reason for non-adherence.

The use of GPA in patients on regular NSAIDs does not improve their overall dyspepsia, but it reduces abdominal pain and burping. Poor adherence to GPA may be a contributing factor.