Journal of Gastroenterology

, Volume 45, Issue 9, pp 944–951

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

  • Hidetaka Tsumura
  • Tsuyoshi Fujita
  • Isamu Tamura
  • Yoshinori Morita
  • Masaru Yoshida
  • Takashi Toyonaga
  • Hidekazu Mukai
  • Hideto Inokuchi
  • Hiromu Kutsumi
  • Takeshi Azuma
Original Article—Alimentary Tract



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.


NSAIDs-guideline Gastric mucosal lesions Adherence 


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Copyright information

© Springer 2010

Authors and Affiliations

  • Hidetaka Tsumura
    • 1
  • Tsuyoshi Fujita
    • 1
  • Isamu Tamura
    • 1
  • Yoshinori Morita
    • 1
  • Masaru Yoshida
    • 1
  • Takashi Toyonaga
    • 1
  • Hidekazu Mukai
    • 2
  • Hideto Inokuchi
    • 3
  • Hiromu Kutsumi
    • 1
  • Takeshi Azuma
    • 1
  1. 1.Department of GastroenterologyKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of GastroenterologyYodogawa Christian HospitalOsakaJapan
  3. 3.Department of GastroenterologyHyogo Cancer CenterAkashiJapan

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