Wilcox C M, Shalek K A, Cotsonis G
Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Arch Intern Med. 1994 Jan 10;154(1):42-6.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-established cause of gastrointestinal disease. There appears to be an association with peptic ulcer disease complications, specifically ulcer-related bleeding. Studies addressing this relationship have primarily evaluated prescription use of these agents. There has been little study of over-the-counter NSAID use in patients with either ulcer or nonulcer-related upper gastrointestinal hemorrhage.
Consecutive patients with upper gastrointestinal hemorrhage evaluated by a gastroenterology consultative service at a large inner-city hospital from August 1, 1990 to July 31, 1992 were identified. The use of any prescription or over-the-counter NSAID during the week before admission was prospectively assessed. Computerized pharmacy records were available for confirmation of prescription drug use.
During the 2-year period of study, 421 patients were evaluated for upper gastrointestinal hemorrhage. The mean age of the patients was 50 years and the majority were male and black. The most common cause of bleeding was peptic ulcer disease, identified in over 50% of patients. Use of an over-the-counter aspirin or nonaspirin NSAID was reported in 145 patients (35%) and 36 patients (9%), respectively, during the week before admission. Prescription use of a nonaspirin NSAID or aspirin was reported in 56 patients (14%) and 27 patients (6%), respectively. The overall prevalence of NSAID use during the week before admission was 56% (95% confidence interval, 51.2% to 60.8%). The use of any NSAID was significantly associated with gastric compared with duodenal ulcer hemorrhage, and ulcer-related bleeding compared with variceal hemorrhage.
Over-the-counter NSAID use is frequent in our patient population and exceeds prescription use. Although ulcer-related bleeding was significantly associated with use of these drugs, NSAIDs were commonly used in patients with nonulcer-related upper gastrointestinal hemorrhage as well. Over-the-counter NSAID use may represent a more important cause of peptic ulcer disease and ulcer-related hemorrhage than previously appreciated.
非甾体抗炎药（NSAIDs）是公认的胃肠道疾病病因。似乎与消化性溃疡疾病并发症，特别是溃疡相关出血有关。探讨这种关系的研究主要评估了这些药物的处方使用情况。对于溃疡或非溃疡相关上消化道出血患者使用非处方NSAIDs的研究很少。
确定了1990年8月1日至1992年7月31日在一家大型市中心医院接受胃肠病学咨询服务评估的连续性上消化道出血患者。前瞻性评估入院前一周内使用任何处方或非处方NSAIDs的情况。可通过计算机化药房记录确认处方药使用情况。
在为期2年的研究期间，421例患者接受了上消化道出血评估。患者的平均年龄为50岁，大多数为男性和黑人。最常见的出血原因是消化性溃疡疾病，超过50%的患者确诊为此病。分别有145例患者（35%）和36例患者（9%）报告在入院前一周使用了非处方阿司匹林或非阿司匹林NSAIDs。分别有56例患者（14%）和27例患者（6%）报告使用了非阿司匹林NSAIDs或阿司匹林处方。入院前一周内NSAIDs使用的总体患病率为56%（95%置信区间，51.2%至60.8%）。与十二指肠溃疡出血相比，使用任何NSAIDs与胃溃疡出血显著相关，与静脉曲张出血相比，与溃疡相关出血显著相关。
在我们的患者群体中，非处方NSAIDs的使用很频繁，且超过了处方使用。虽然溃疡相关出血与这些药物的使用显著相关，但NSAIDs也常用于非溃疡相关上消化道出血的患者。非处方NSAIDs的使用可能是消化性溃疡疾病和溃疡相关出血比以前认为的更重要的原因。
