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Summing Up the Risk for NSAID-Associated UGI Complications

The major limitation in the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the risk for upper gastrointestinal complications (e.g., bleeding, perforation, and hospitalization). Multiple epidemiologic studies have yielded differing estimates of such risks. To provide a more accurate assessment of the risk, these authors performed a meta-analysis of epidemiologic data published from 1990 through 1999. They used a Medline search to identify 18 well-designed studies based on explicit quality criteria and pooled the data to quantify the effect of NSAIDs and other factors on the risk for upper GI complications.

The pooled odds ratio for upper GI complications with NSAID use was 3.8 (95 percent CI, 3.6-4.1). Independent risk factors for events included a history of peptic ulcer disease (OR, 5.9; 95 percent CI, 5.2-6.7); complicated peptic ulcer disease (OR, 15.4; 95 percent CI, 12.6-18.9); advanced age (OR range, 1.8 for age 50-59 to 9.2 for age (greater than) 80); and male sex (OR, 2.1; 95 percent CI, 1.9-2.3). Each of these variables contributed to the isolated effect of NSAIDs on the risk for complications, but the effects of multiple risk factors were not additive. There were inadequate data to provide meaningful estimates of risk differences among different NSAIDs.

Comment: The results of this meta-analysis are consistent with those of prior studies but may be more robust because of the use of pooled data. Unfortunately, even with pooled data, the issue of variance in risk among individual NSAIDs remains difficult to address.

— DJ Bjorkman

Published in Journal Watch Gastroenterology August 28, 2000

Citation(s):

Hernandez-Diaz S and Rodriguez LAG. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: An overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000 Jul 24 160 2093-2099.

• Original article (Subscription may be required)
• Medline abstract (Free)