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Nonsteroidal antiinflammatory drug-induced gastroduodenal injury in children
Insights
Nonsteroidal anti-inflammatory drug (NSAID) use in children with arthritis frequently causes gastroduodenal injury, similar to adults. While the risk is elevated, severe outcomes like hospitalization or death are rare.
Area of Science:
- Pediatric Rheumatology
- Gastroenterology
- Pharmacology
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for children with arthritis.
- Potential gastrointestinal side effects of NSAIDs, particularly gastroduodenal injury, are a concern.
Purpose of the Study:
- To investigate the incidence of abdominal pain and gastroduodenal injury in pediatric arthritis patients using NSAIDs.
Main Methods:
- Retrospective review of 570 pediatric rheumatology patients' records from 1991-1993.
- Analysis of NSAID use, reported abdominal pain, and radiographic/endoscopic findings of gastroduodenal injury.
Main Results:
- NSAID use was associated with a higher incidence of abdominal pain (27.9% vs 14.6%).
- Gastroduodenal injury was found in 34.0% of NSAID users versus 7.1% of non-users, a relative risk of 4.8 (P=0.09).
- No hospitalizations or deaths due to gastroduodenal injury occurred.
Conclusions:
- NSAID use in children with arthritis is frequently linked to gastroduodenal injury.
- The relative risk of injury in children is comparable to that observed in adults.
- Serious complications from NSAID-induced gastroduodenal injury are uncommon in this pediatric population.
Objective:
To determine the incidence of abdominal pain and gastroduodenal injury in children with arthritis taking nonsteroidal antiinflammatory drugs (NSAIDs).
Methods:
A retrospective review of the records of all children (570 patients) receiving followup care in an academic rheumatology clinic between 1991 and 1993 was performed.
Results:
There were 344 patients who used NSAIDs during the study period. Abdominal pain was recorded in 27.9% of patients taking NSAIDs and 14.6% of patients not taking NSAIDs. Abdominal pain in 47 patients (49%) taking NSAIDs and 14 patients (42%) not taking NSAIDs was evaluated radiographically and/or endoscopically. Among those patients evaluated, gastric or duodenal injury was found in 16 (34.0%) who were taking NSAIDs and 1 (7.1%) who were not. This represented a relative risk for gastroduodenal injury of 4.8 for patients taking NSAIDs (P = 0.09). The incidence of injury did not change when analyses were controlled for prednisone or slow-acting antirheumatic drug use. None of the children were hospitalized or died as a result of gastroduodenal injury during the 3-year period.
Conclusion:
We conclude that NSAID use in children with arthritis frequently leads to gastroduodenal injury, with an estimated incidence and relative risk that are comparable to the rates found in adults with arthritis taking NSAIDs, but that hospitalization or death as a result of this injury is uncommon.