Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study
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This population-based survey was conducted to provide a formal description of upper gastrointestinal bleeding (UGIB) in children on a nationwide basis and assess the contribution of risk factors, principally nonsteroidal anti-inflammatory drugs (NSAID).
A case-crossover study of UGIB patients aged between 2 months and 16 years was conducted in France. Medical data were collected by physicians, and personal risk factors and exposure to drugs during the month preceding the onset of the bleeding was ascertained by a standardised telephone interview with parents. The odds ratios for UGIB and NSAID was assessed by comparing exposure during the 7 days preceding the date of hospitalisation and the 21st to the 28th days before that date.
A total of 177 children with UGIB were included over 2 years. Eighty-three children had taken at least one NSAID before the index date, among which 58 were ibuprofen, 26 aspirin and nine others. The adjusted odds ratio (OR) of exposure was 8.2 [95% confidence interval (CI) 2.6–26.0] for NSAIDs altogether, and this was 10.0 (95% CI 2.0–51.0) for ibuprofen and 7.3 (95% CI 0.9–59.4) for aspirin. There was no increased risk associated with NSAIDS for oesophageal lesion [OR = 1.0 [(5% CI:0.2–7.2)].
The study confirms that UGIB is rare but that some cases may be avoided, as one third of the cases was attributable to exposure to NSAID at doses used for analgesic or antipyretic purposes, which may be attained with alternative therapy. The findings from this study call for more caution in prescribing NSAIDS to children.
KeywordsUpper gastrointestinal bleeding Nonsteroidal anti-inflammatory drug Children Case-crossover Ibuprofen
The authors thank Richard Medeiros (Rouen University Hospital Medical Editor) for editing the manuscript.
This study was supported by research grants from the French Agency of Medical Security of Health Products (AFSSAPS).
Conflict of interest statements
None of the authors have financial or personal relationships, academic competition or intellectual commitments that might bias the work or interfere with objective judgment.
Access to data
Lamiae Grimaldi-Bensouda, Elisabeth Autret-Leca and Benoit David had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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