使用非选择性非甾体抗炎药或昔布类药物的老年门诊患者的上消化道症状及治疗

Upper gastrointestinal symptoms and therapies in elderly out-patients, users of non-selective NSAIDs or coxibs.

作者信息

Pilotto A, Franceschi M, Vitale D F, Zaninelli A, Masotti G, Rengo F

机构信息

Unità Operativa di Geriatria, Casa Sollievo della Sofferenza, IRCCS, San Giovanni Rotondo (FG), Italy.

出版信息

Aliment Pharmacol Ther. 2005 Jul 15;22(2):147-55. doi: 10.1111/j.1365-2036.2005.02537.x.

DOI:10.1111/j.1365-2036.2005.02537.x

PMID:16011673

Abstract

BACKGROUND

The association between coxib or non-steroidal anti-inflammatory drug use with gastrointestinal symptoms and drug prescriptions in ambulatory elderly patients is not well defined.

AIM

To evaluate the association between non-steroidal anti-inflammatory drug NSAID and coxib use with gastrointestinal symptoms and therapies in elderly subjects managed by their general practitioner.

MATERIALS

The study was carried out by 133 general practitioners in Italy. By using a structured interview, sex, age, physical function, current medications, new drug prescriptions and upper gastrointestinal symptoms were registered from all elderly subjects who were referred to their general practitioners during a 2-week period. The numbers of hospitalizations, gastrointestinal bleeding events and gastrointestinal diagnostic procedures occurring during the last 6-month period were recorded.

RESULTS

Included in this study were 5515 elderly subjects. The overall prevalence of drug use was 92%. Musculo-skeletal drugs were taken by 15% of patients; NSAIDs were taken by 6%, and coxibs by 3% of patients. A significantly higher prevalence of upper gastrointestinal symptoms was observed in elderly NSAID users compared with coxib users and non-users of musculo-skeletal drugs (44% vs. 33% vs. 32% respectively, P = 0.001). The prescriptions of drugs for acid-related disorders were significantly higher in patients who were concomitantly taking NSAID rather than coxibs (13% vs. 6%, P < 0.01). The prescriptions of drugs for acid-related disorders were significantly associated with the presence of upper gastrointestinal symptoms (OR = 1.7, 95% CI = 1.6-1.9), previous gastrointestinal disorders (OR = 1.1, 95% CI = 1.0-1.3) and NSAID use (OR = 1.5, 95% CI = 1.0-2.2), but no coxib use.

CONCLUSION

In this elderly population, upper gastrointestinal symptoms and prescriptions for gastroenterological drugs were higher in non-steroidal anti-inflammatory drug users than coxib users and non-users of musculo-skeletal drugs.

摘要

背景

在非卧床老年患者中，昔布类药物或非甾体抗炎药的使用与胃肠道症状及药物处方之间的关联尚不明确。

目的

评估在由全科医生管理的老年患者中，非甾体抗炎药（NSAID）和昔布类药物的使用与胃肠道症状及治疗之间的关联。

材料

该研究由意大利的133名全科医生开展。通过结构化访谈，记录了在两周内被转诊至其全科医生处的所有老年患者的性别、年龄、身体功能、当前用药情况、新药处方以及上胃肠道症状。记录了过去6个月内发生的住院次数、胃肠道出血事件及胃肠道诊断程序的数量。

结果

本研究纳入了5515名老年患者。药物使用的总体患病率为92%。15%的患者服用肌肉骨骼药物；6%的患者服用NSAIDs，3%的患者服用昔布类药物。与昔布类药物使用者和未使用肌肉骨骼药物的患者相比，老年NSAID使用者中上胃肠道症状的患病率显著更高（分别为44%、33%和32%，P = 0.001）。同时服用NSAID而非昔布类药物的患者中，与酸相关疾病的药物处方显著更高（13%对6%，P < 0.01）。与酸相关疾病的药物处方与上胃肠道症状的存在（比值比[OR]=1.7，95%置信区间[CI]=1.6 - 1.9）、既往胃肠道疾病（OR = 1.1，CI = 1.0 - 1.3）及NSAID使用（OR = 1.5，CI = 1.0 - 2.2）显著相关，但与昔布类药物的使用无关。