The changing face of peptic ulceration

Area of Science:

• Gastroenterology
• Pharmacology
• Epidemiology

Background:

• Non-steroidal anti-inflammatory drugs (NSAIDs) are widely prescribed, with millions of prescriptions issued annually.
• Gastrointestinal (GI) side effects are common complaints associated with NSAID use.
• Spontaneous reports of serious GI adverse effects are the most frequent type reported to regulatory bodies.

Purpose of the Study:

• To investigate the association between non-aspirin NSAID use and serious gastrointestinal complications.
• To reconcile conflicting findings from different study designs regarding NSAID-induced ulcers.

Main Methods:

• Review of experimental studies (animal and human).
• Analysis of clinical case series.
• Evaluation of surveillance studies.
• Conducting formal case-control studies.

Main Results:

• Experimental studies suggest NSAIDs can cause gastritis and erosions.
• Case series indicate a high proportion of bleeding/perforated ulcers in NSAID users.
• Surveillance studies showed no significant difference in ulcer complication rates between users and non-users.
• Case-control studies revealed a 2- to 4-fold increased relative risk for gastric and duodenal ulcers in elderly NSAID users.

Conclusions:

• The high number of NSAID prescriptions can explain the apparent discrepancy between surveillance and case-control study findings.
• NSAID use, particularly in the elderly, is associated with an increased risk of serious gastric and duodenal ulcer complications.
• Further research is needed to fully elucidate the complex relationship between NSAIDs and GI adverse events.