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
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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.
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).
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).
Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.
- Clinard Francois, Bardou Marc, Sgro Catherine, Lefevre Nathalie, Raphael Francis, Paille Francois, et al. Non-steroidal anti-inflammatory and cytoprotective drug co-prescription in general practice. Eur J Clin Pharmacol. 2001;57:737–43. CrossRef
- Taha AS, Hudson N, Hawkey CJ, Swannell AJ, Trye PN, Cottrell J, et al. Famotidine for the prevention of gastric and duodenal ulcers caused by nonsteroidal anti-inflammatory drugs. N Engl J Med. 1996;334:1435–9. CrossRef
- Weil J, Langman MJ, Wainwright P, Lawson DH, Rawlins M, Logan RF, et al. Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti-inflammatory drugs. Gut. 2000;46:27–31. CrossRef
- Shiokawa Y, Nobenaga T, Saitoh T, Asaji S, Ogawa A. Epidemiological study on upper digestive injuries by non-steroidal anti-inflammatory drugs. J Jpn Rheum Assoc. 1991;31:96–111 (in Japanese).
- Gabriel SE, Jaakkinmainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs: a meta-analysis. Ann Intern Med. 1991;115:787–96.
- Bellary SV, Isaacs PE, Lee FI. Upper gastrointestinal lesions in elderly patients presenting for endoscopy; relevance of NSAID usage. Am J Gastroenterol. 1991;86:961–4.
- Fries JF, Williams CA, Bloch DA, Michel DA. Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models. Am J Med. 1991;91:213–22. CrossRef
- Lanza FL, Chan FK, Quigley EM. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728–38. CrossRef
- Recommendation for the medical management of osteoarthritis of the hip and knee. 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum 2000;43:1905–15.
- Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers: members of the ad hoc committee on practice parameters of the American college of gastroenterology. Am J Gastroenterol. 1998;93(11):2037–46. CrossRef
- MacLean CH. Quality indicators for the management of osteoarthritis in vulnerable elders. Ann Intern Med. 2001;135:711–21.
- Abrahama NS, El-Serag HB, Johnson ML, Hartman C, Richardson P, Ray WA, et al. National adherence to evidence-based guidelines for the prescription of nonsteroidal anti-inflammatory drugs. Gastroenterology. 2005;129(4):1171–8. CrossRef
- Smalley WE, Griffin MR. The risks and costs of upper gastrointestinal disease attributable to NSAIDs. Gastroenterol Clin North Am. 1996;25(2):373–96. CrossRef
- Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation. Arch Intern Med. 2000;160:2093–9. CrossRef
- Moens HJ, Van Croonenborg JJ, Al MJ, van den Bemt PM, Lourens J, Numans ME, et al. Guideline: ‘NSAID use and the prevention of gastric damage’. Ned Tijdschr Geneeskd. 2003;148:604–8.
- Wofe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Eng J Med. 1999;340:1888–99. CrossRef
- van Soest EM, Sturkenboom MC, Dieleman JP, Verhamme KM, Siersema PD, Kuipers EJ. Adherence to gastroprotection and the risk of NSAID-related upper gastrointestinal ulcers and haemorrhage. Aliment Pharmacol Ther. 2007;26(2):265–75. CrossRef
- Lanza FL, Fakouhi D, Rubin A, Davis RE, Rack MF, Nissen C, et al. A double-blind placebo-controlled comparison of the efficacy and safety of 50, 100, and 200 micrograms of misoprostol q.i.d. in the prevention of ibuprofen-induced gastric and duodenal mucosal lesions and symptoms. Am J Gastroenterol. 1989;84:633–6.
- Targownik LE, Metge CJ, Leung S, Chateau DG. The relative efficacies of gastroprotective strategies in chronic users of nonsteroidal anti-inflammatory drugs. Gastroenterology. 2008;134:937–44. CrossRef
- Lanza FL. A double-blind study of prophylactic effect of misoprostol on lesions of gastric and duodenal mucosa induced by oral administration of tolmetin in healthy subjects. Dig Dis Sci. 1986;31:131–6. CrossRef
- Hawkey C, Talley NJ, Yeomans ND, Jones R, Sung JJ, Langstrom G, et al. Improvements with esomeprazole in patients with upper gastrointestinal symptoms taking non-steroidal anti-inflammatory drugs, including selective COX-2 inhibitors. Am J Gastroenterol. 2005;100:1028–36. CrossRef
- Hooper L, Brown TJ, Elliott R, Payne K, Roberts C, Symmons D. The effectiveness of five strategies for the prevention of gastrointestinal toxicity induced by non-steroidal anti-inflammatory drugs: systematic review. BMJ. 2004;329:948. CrossRef
- Rostom A, Dube C, Wells G, Tugwell P, Welch V, Jolicoeur E, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev. 2002;(4):CD002296.
- Scheiman JM, Yeomans ND, Talley NJ, Vakil N, Chan FK, Tulassay Z, et al. Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAIDs and COX-2 inhibitors. Am J Gastroenterol. 2006;101(4):701–10. CrossRef
- Tsumura H, Tamura I, Tanaka H, Chinzei R, Ishida T, Masuda A, et al. Prescription of non steroidal anti-inflammatory drugs and co-prescribed drugs for mucosal protection: analysis of the present status based on questionnaires obtained from orthopedists in Japan. Intern Med. 2007;46:927–31. CrossRef
- EBM ni motozuku ikaiyou shinnryou gaidolain dai2han. NSAID kaiyou yobou. in EBM ni motozuku ikaiyou shinnryou gaidolain. Jihou, 2007 (in Japanese).
- Schnitzer TJ, American College of Rheumatology. Update of ACR guidelines for osteoarthritis: role of the coxibs. J Pain Symptom Manage. 2002;23(Suppl 4):S24–30. CrossRef
- Sorensen R, Hansen ML, Abildstrom SZ, Hvelplund A, Torp-Pedersen C, Gislason GH. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Demark: a retrospective analysis of nationwide registry data. Lancet. 2009;374:1967–74. CrossRef
- Naito Y, Yoshikawa T, Iinuma S, Yagi N, Matsuyama K, Boku Y, et al. Rebamipide protects against indomethacin-induced gastric mucosal injury in healthy volunteers in a double-blind, placebo-controlled study. Dig Dis Sci. 1998;43:83–9.
- Lanza FL, Royer GL, Nelson RS, Chen TT, Sechman CE, Rack MF. A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gatroenterol. 1981;75:17–21.
- Kobayashi K, Mizushima Y, Yanagawa A, Kasukawa R, Ito J, Koshino T, et al. Prophylactic effects ranitidine, a H2 receptor antagonist, on gastric and duodenal lesions induced by nonsteroidal anti-inflammatory agents. J Adult Dis. 1990;20:253–64 (in Japanese).
- Robinson MG, Griffin JW, Bowers J, Kogan FJ, Kogut DG, Lanza FL, et al. Effect on ranitidine on gastroduodenal mucosal damage induced by nonsteroidal anti-inflammatory drugs. Dig Dis Sci. 1989;34:424–8. CrossRef
- Yeomans ND, Naesdal J. Systematic review: ulcer definition in NSAID ulcer prevention trials. Aliment Pharmacol Ther. 2008;27:465–72. CrossRef
- Suh D-C, Hunsche E, Shin H-C, Mavros P. Co-prescribing of proton pump inhibitors among chronic users of NSAIDs in the UK. Rheumatology. 2008;47:458–63. CrossRef
- Arakawa T, Fujiwara Y, Sollano JD, Ahu Q, Kachintorn U, Rani AA, et al. IGIS study group: a questionnaire-based survey on the prescription of non-steroidal anti-inflammatory drugs by physicians in East Asian countries in 2007. Digestion. 2009;79:177–85. CrossRef
- Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal anti-inflammatory drugs in peptic-ulcer disease: a meta-analysis. Lancet. 2002;359:14–22. CrossRef
- Coté GA, Rice JP, Bulsiewicz W, Norvell JP, Christensen K, Bobb A, et al. Use of physician education and computer alert to improve targeted use of gastroprotection among NSAID users. Am J Gastroenterol. 2008;103:1097–103. CrossRef
- 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
Journal of Gastroenterology
Volume 45, Issue 9 , pp 944-951
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- Gastric mucosal lesions
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- Author Affiliations
- 1. Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
- 2. Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Osaka, Japan
- 3. Department of Gastroenterology, Hyogo Cancer Center, Akashi, Hyogo, Japan