Sostres Carlos, Carrera-Lasfuentes Patrica, Lanas Angel
a Service of Digestive Diseases, University Clinic Hospital Lozano Blesa , Zaragoza , Spain.
b Aragón Health Research Institute (IIS Aragón) , Spain.
Curr Med Res Opin. 2017 Oct;33(10):1815-1820. doi: 10.1080/03007995.2017.1338178. Epub 2017 Jul 5.
The best available evidence regarding non-steroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) bleeding comes from randomized controlled trials including patients who use NSAIDs to manage chronic rheumatic diseases; however, patients with varying background profiles commonly take NSAIDs for many other reasons, often without prescription, and such usage has not been well studied.
To define the characteristics of patients hospitalized for upper GI bleeding in clinical practice, we conducted a case-control study among patients with endoscopy-proven major upper GI bleeding due to gastroduodenal peptic lesions and control subjects. We used adjusted logistic regression models to estimate bleeding risks. Data analysis was performed using SPSS 22.0.
Our analysis included 3785 cases and 6540 controls, including 1270 cases (33.55%) and 834 controls (12.75%) reporting recent use (<30 days) of NSAIDs including high-dose acetylsalicylic acid (ASA). NSAID use was associated with increased risk of upper GI bleeding, with an adjusted relative risk of 4.86 (95% CI, 4.32-5.46). Acute musculoskeletal pain (36.1%), chronic osteoarthritis (13.5%), and headache (13.6%) were the most common reasons for NSAID use. Among cases, only 17.31% took NSAIDs and 6.38% took high dose ASA due to chronic osteoarthritis. Demographic characteristics significantly differed between subjects with chronic vs. acute musculoskeletal pain. Proton pump inhibitor use was significantly higher in patients who used NSAIDs due to chronic osteoarthritis compared to patients with acute musculoskeletal pain. NSAID (65.15%) or high-dose ASA use (65.83%) preceding upper GI bleeding was most often short-term. In over half of cases (63.62%), the upper GI bleeding event was not preceded by dyspeptic warning symptoms.
The majority of patients hospitalized due to NSAID-related upper GI bleeding reported short-term NSAID use for reasons other than chronic rheumatic disease. These findings suggest that current prevention strategies may not reach a wide population of short-term NSAID users.
关于非甾体抗炎药（NSAID）相关胃肠道（GI）出血的最佳现有证据来自随机对照试验，这些试验纳入了使用NSAIDs治疗慢性风湿性疾病的患者；然而，背景特征各异的患者常因许多其他原因服用NSAIDs，且通常无处方，这种用药情况尚未得到充分研究。
为明确临床实践中因上消化道出血住院患者的特征，我们对因胃十二指肠消化性病变导致经内镜证实的严重上消化道出血的患者及对照进行了病例对照研究。我们使用校正逻辑回归模型来估计出血风险。使用SPSS 22.0进行数据分析。
我们的分析纳入了3785例病例和6540例对照，其中1270例病例（33.55%）和834例对照（12.75%）报告近期（<30天）使用过NSAIDs，包括高剂量阿司匹林（ASA）。使用NSAIDs与上消化道出血风险增加相关，校正相对风险为4.86（95%CI，4.32 - 5.46）。急性肌肉骨骼疼痛（36.1%）、慢性骨关节炎（13.5%）和头痛（13.6%）是使用NSAIDs的最常见原因。在病例中，仅17.31%因慢性骨关节炎服用NSAIDs，6.38%服用高剂量ASA。慢性与急性肌肉骨骼疼痛患者的人口统计学特征存在显著差异。因慢性骨关节炎使用NSAIDs的患者中质子泵抑制剂的使用显著高于急性肌肉骨骼疼痛患者。上消化道出血前使用NSAIDs（65.15%）或高剂量ASA（65.83%）大多为短期使用。在超过一半的病例（63.62%）中，上消化道出血事件之前没有消化不良的警示症状。
因NSAID相关上消化道出血住院的大多数患者报告因慢性风湿性疾病以外的原因短期使用NSAIDs。这些发现表明，当前的预防策略可能无法覆盖广大短期NSAID使用者群体。
