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Association between adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs and the incidence of gastric mucosal lesions in Japanese patients

  • Original Article—Alimentary Tract
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Abstract

Objective

Recently, guidelines for the treatment and prevention of ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) were established. This study investigated the association between the current adherence to the guidelines and the incidence of gastric mucosal lesions caused by NSAIDs.

Methods

This study included 254 NSAIDs users (128 regular and 126 on-demand users) who had undergone upper gastrointestinal endoscopy. The patients were characterized as high risk based on the following: age 65 years or older, history of peptic ulcers, concurrent use of corticosteroids or anticoagulants, and high-dose NSAIDs use. Adherence was defined as the prescription of NSAIDs with proton pump inhibitors, prostaglandin analogues, or high-dose histamine 2 receptor antagonists in high-risk NSAIDs user. The severity of gastric mucosal lesions was evaluated using the modified LANZA score (MLS).

Results

Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of the on-demand NSAIDs users met our definition of high-risk patients. Adherence in the regular NSAIDs users and on-demand NSAIDs users was 25 (31.7%) and 16 (24.6%), respectively. The incidence of gastric mucosal lesions (MLS ≧ 1) was significantly higher in the nonadherence group than in the adherence group for both regular NSAIDs users (59.3 vs. 28.0%, P = 0.01) and on-demand NSAIDs users (63.3 vs. 25.0%, P = 0.01). Gastric ulcers in the regular NSAIDs users were more frequently observed in the nonadherence group than in the adherence group (29.6 vs. 4.0%, P < 0.01).

Conclusion

Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.

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Acknowledgments

This study was supported by a grant for the Global COE Program “Global Center of Excellence for Education and Research on Signal Transduction Medicine in the Coming Generation” from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (T.A.).

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Authors and Affiliations

  1. Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Hidetaka Tsumura, Tsuyoshi Fujita, Isamu Tamura, Yoshinori Morita, Masaru Yoshida, Takashi Toyonaga, Hiromu Kutsumi & Takeshi Azuma

  2. Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Osaka, Japan

    Hidekazu Mukai

  3. Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan

    Hideto Inokuchi

Authors
  1. Hidetaka Tsumura
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  2. Tsuyoshi Fujita
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  3. Isamu Tamura
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  4. Yoshinori Morita
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  9. Hiromu Kutsumi
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  10. Takeshi Azuma
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Correspondence to Takeshi Azuma.

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Tsumura, H., Fujita, T., Tamura, I. et al. Association between adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs and the incidence of gastric mucosal lesions in Japanese patients. J Gastroenterol 45, 944–951 (2010). https://doi.org/10.1007/s00535-010-0236-2

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  • DOI: https://doi.org/10.1007/s00535-010-0236-2

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