Striking Prevalence of Over-the-Counter Nonsteroidal Anti-inflammatory Drug Use in Patients With Upper Gastrointestinal Hemorrhage

doi:10.1001/archinte.1994.00420010064008

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Vol. 154 No. 1, 10 January 1994

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Striking Prevalence of Over-the-Counter Nonsteroidal Anti-inflammatory Drug Use in Patients With Upper Gastrointestinal Hemorrhage

C. Mel Wilcox, MD; Karen A. Shalek, RN; George Cotsonis, MS

Arch Intern Med. 1994;154(1):42-46.

Abstract

Background
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a well-establishedcause of gastrointestinal disease. There appears to be an associationwith peptic ulcer disease complications, specifically ulcerrelatedbleeding. Studies addressing this relationship have primarilyevaluated prescription use of these agents. There has been littlestudy of over-the-counter NSAID use in patients with eitherulcer or nonulcer-related upper gastrointestinal hemorrhage.

Methods
Consecutive patients with upper gastrointestinal hemorrhageevaluated by a gastroenterology consultative service at a largeinner-city hospital from August 1, 1990 to July 31, 1992 wereidentified. The use of any prescription or over-the-counterNSAID during the week before admission was prospectively assessed.Computerized pharmacy records were available for confirmationof prescription drug use.

Results
During the 2-year period of study, 421 patients were evaluatedfor upper gastrointestinal hemorrhage. The mean age of the patientswas 50 years and the majority were male and black. The mostcommon cause of bleeding was peptic ulcer disease, identifiedin over 50% of patients. Use of an over-the-counter aspirinor nonaspirin NSAID was reported in 145 patients (35%) and 36patients (9%), respectively, during the week before admission.Prescription use of a nonaspirin NSAID or aspirin was reportedin 56 patients (14%) and 27 patients (6%), respectively. Theoverall prevalence of NSAID use during the week before admissionwas 56% (95% confidence interval, 51.2% to 60.8%). The use ofany NSAID was significantly associated with gastric comparedwith duodenal ulcer hemorrhage, and ulcer-related bleeding comparedwith variceal hemorrhage.

Conclusions
Over-the-counter NSAID use is frequent in our patient populationand exceeds prescription use. Although ulcer-related bleedingwas significantly associated with use of these drugs, NSAIDswere commonly used in patients with nonulcer-related upper gastrointestinalhemorrhage as well. Over-the-counter NSAID use may representa more important cause of peptic ulcer disease and ulcer-relatedhemorrhage than previously appreciated.

(Arch Intern Med. 1994;154:42-46)

Author Affiliations

From the Department of Medicine, Emory University School of Medicine and School of Public Health, Emory University, and the Medical Service, Grady Memorial Hospital, Atlanta, Ga.

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