Skip to main content
Erschienen in: Arthritis Research & Therapy 2/2001

01.01.2001 | Review

The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents

verfasst von: Luis Alberto García Rodríguez, Sonia Hernández-Díaz

Erschienen in: Arthritis Research & Therapy | Ausgabe 2/2001

Einloggen, um Zugang zu erhalten

Abstract

Most anti-inflammatory drugs have been associated with an increased risk of serious upper gastrointestinal complications. Epidemiological studies have estimated the magnitude of the risk for specific anti-inflammatory drugs. The risk of upper gastrointestinal tract bleeding or perforation increases around twofold with use of oral steroids or low dose aspirin, and increases around fourfold with use of nonaspirin nonsteroidal anti-inflammatory drugs. Acetaminophen at daily doses of 2000 mg and higher has also been associated with an increased risk. Overall, the risk is dose dependent and is greater with more than one anti-inflammatory drug taken simultaneously. Hence, whenever possible, anti-inflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce the risk of serious upper gastrointestinal complications.
Literatur
1.
Zurück zum Zitat Piper JM, Ray WA, Daugherty JR, Griffin MR: Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Internal Med. 1991, 114: 735-740.CrossRef Piper JM, Ray WA, Daugherty JR, Griffin MR: Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs. Ann Internal Med. 1991, 114: 735-740.CrossRef
2.
Zurück zum Zitat Holvoet J, Terriere L, Van Hee W, Verbist L, Fierens E, Hautekeete M: Relation of upper gastrointestinal bleeding to non-steroidal anti-inflammatory drugs and aspirin: a case-control study. Gut. 1991, 32: 730-734.CrossRef Holvoet J, Terriere L, Van Hee W, Verbist L, Fierens E, Hautekeete M: Relation of upper gastrointestinal bleeding to non-steroidal anti-inflammatory drugs and aspirin: a case-control study. Gut. 1991, 32: 730-734.CrossRef
3.
Zurück zum Zitat Keating J: Anti-inflammatory drugs and emergency surgery for peptic ulcers in the Waikato. NZ Med J. 1992, 105: 127-129. Keating J: Anti-inflammatory drugs and emergency surgery for peptic ulcers in the Waikato. NZ Med J. 1992, 105: 127-129.
4.
Zurück zum Zitat Hallas J, Lauritsen J, Dalsgard Villadsen H, Freng Gram L: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, identifying high-risk groups by excess risk estimates. Scand J Gastroenterol. 1995, 30: 438-444.CrossRef Hallas J, Lauritsen J, Dalsgard Villadsen H, Freng Gram L: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, identifying high-risk groups by excess risk estimates. Scand J Gastroenterol. 1995, 30: 438-444.CrossRef
5.
Zurück zum Zitat Pérez-Gutthann S, García Rodríguez LA, Raiford DS: Individual nonsteroidal anti-inflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation. Epidemiology. 1997, 8: 18-24.CrossRef Pérez-Gutthann S, García Rodríguez LA, Raiford DS: Individual nonsteroidal anti-inflammatory drugs and other risk factors for upper gastrointestinal bleeding and perforation. Epidemiology. 1997, 8: 18-24.CrossRef
6.
Zurück zum Zitat García Rodríguez LA, Cattaruzzi C, Troncon MG, Agostinis L: Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Internal Med. 1998, 158: 33-39. 10.1001/archinte.158.1.33.CrossRef García Rodríguez LA, Cattaruzzi C, Troncon MG, Agostinis L: Risk of hospitalization for upper gastrointestinal tract bleeding associated with ketorolac, other nonsteroidal anti-inflammatory drugs, calcium antagonists, and other antihypertensive drugs. Arch Internal Med. 1998, 158: 33-39. 10.1001/archinte.158.1.33.CrossRef
7.
Zurück zum Zitat Henry D, Dobson A, Truner C: Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs. Gastroenterology. 1993, 105: 1078-1088.CrossRef Henry D, Dobson A, Truner C: Variability in the risk of major gastrointestinal complications from nonaspirin nonsteroidal anti-inflammatory drugs. Gastroenterology. 1993, 105: 1078-1088.CrossRef
8.
Zurück zum Zitat Savage R, Moller P, Ballantyne C, Wells J: Variation in the risk of peptic ulcer complications with nonsteroidal anti-inflammatory drug therapy. Arthritis Rheum. 1993, 36: 84-90.CrossRef Savage R, Moller P, Ballantyne C, Wells J: Variation in the risk of peptic ulcer complications with nonsteroidal anti-inflammatory drug therapy. Arthritis Rheum. 1993, 36: 84-90.CrossRef
9.
Zurück zum Zitat Weil J, Colin-Jones D, Langman M, Lawson D, Logan R, Murphy M, Rawlins M, Vessey M, Wainwright P: Prophylactic aspirin and risk of peptic ulcer bleeding. Br Med J. 1995, 310: 827-830.CrossRef Weil J, Colin-Jones D, Langman M, Lawson D, Logan R, Murphy M, Rawlins M, Vessey M, Wainwright P: Prophylactic aspirin and risk of peptic ulcer bleeding. Br Med J. 1995, 310: 827-830.CrossRef
10.
Zurück zum Zitat Kelly JP, Kaufman DW, Jugelon JM, Sheehan JE, Koff RS, Shapiro S: Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet. 1996, 348: 1414-1416. 10.1016/S0140-6736(96)01254-8. Kelly JP, Kaufman DW, Jugelon JM, Sheehan JE, Koff RS, Shapiro S: Risk of aspirin-associated major upper-gastrointestinal bleeding with enteric-coated or buffered product. Lancet. 1996, 348: 1414-1416. 10.1016/S0140-6736(96)01254-8.
11.
Zurück zum Zitat García Rodríguez LA, Jick H: Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994, 343: 769-772. 10.1016/S0140-6736(94)91843-0.CrossRef García Rodríguez LA, Jick H: Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994, 343: 769-772. 10.1016/S0140-6736(94)91843-0.CrossRef
12.
Zurück zum Zitat Hernández-Díaz S, García-Rodríguez L: Steroids and risk of upper gastrointestinal bleeding/perforation. Am J Epidemiol. 2000, Hernández-Díaz S, García-Rodríguez L: Steroids and risk of upper gastrointestinal bleeding/perforation. Am J Epidemiol. 2000,
13.
Zurück zum Zitat De Abajo FJ, García Rodríguez LA: Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations [abstract]. Pharmacoepidemiol Drug Safety. 2000, 8: S174- De Abajo FJ, García Rodríguez LA: Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric-coated formulations [abstract]. Pharmacoepidemiol Drug Safety. 2000, 8: S174-
14.
Zurück zum Zitat Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC: Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983, 309: 21-24.CrossRef Messer J, Reitman D, Sacks HS, Smith H, Chalmers TC: Association of adrenocorticosteroid therapy and peptic-ulcer disease. N Engl J Med. 1983, 309: 21-24.CrossRef
15.
Zurück zum Zitat Conn H, Poynard T: Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Internal Med. 1994, 236: 619-632.CrossRef Conn H, Poynard T: Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Internal Med. 1994, 236: 619-632.CrossRef
16.
Zurück zum Zitat Gabriel SE, Jaakkimainen L, Bombardier C: Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. Ann Internal Med. 1991, 115: 787-796.CrossRef Gabriel SE, Jaakkimainen L, Bombardier C: Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. Ann Internal Med. 1991, 115: 787-796.CrossRef
17.
Zurück zum Zitat Bollini P, García Rodríguez LA, Pérez Gutthann S, Walker AM: The impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti-inflammatory drugs on upper gastrointestinal tract disease. Arch Internal Med. 1992, 152: 1289-1295. 10.1001/archinte.152.6.1289.CrossRef Bollini P, García Rodríguez LA, Pérez Gutthann S, Walker AM: The impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti-inflammatory drugs on upper gastrointestinal tract disease. Arch Internal Med. 1992, 152: 1289-1295. 10.1001/archinte.152.6.1289.CrossRef
18.
Zurück zum Zitat Henry D, Lim LL, García Rodríguez LA, Perez Gutthann S, Carson JL, Griffin M, Savage R, Logan R, Moride Y, Hawkey C, Hill S, Fries JT: Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. Br Med J. 1996, 312: 1563-1566.CrossRef Henry D, Lim LL, García Rodríguez LA, Perez Gutthann S, Carson JL, Griffin M, Savage R, Logan R, Moride Y, Hawkey C, Hill S, Fries JT: Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis. Br Med J. 1996, 312: 1563-1566.CrossRef
19.
Zurück zum Zitat Hernández-Díaz S, García-Rodríguez LA: Overview of epidemiological studies published in the nineties on the association between non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding/perforation. Arch Internal Med. 2000, 160: 2093-2099. 10.1001/archinte.160.14.2093.CrossRef Hernández-Díaz S, García-Rodríguez LA: Overview of epidemiological studies published in the nineties on the association between non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding/perforation. Arch Internal Med. 2000, 160: 2093-2099. 10.1001/archinte.160.14.2093.CrossRef
20.
Zurück zum Zitat Laporte J-R, Carné X, Vidal X, Moreno V, Juan J: Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Lancet. 1991, 337: 85-89. 10.1016/0140-6736(91)90744-A.CrossRef Laporte J-R, Carné X, Vidal X, Moreno V, Juan J: Upper gastrointestinal bleeding in relation to previous use of analgesics and non-steroidal anti-inflammatory drugs. Lancet. 1991, 337: 85-89. 10.1016/0140-6736(91)90744-A.CrossRef
21.
Zurück zum Zitat Nobili A, Mosconi P, Franzosi MG, Tognoni G: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, a post-marketing surveillance case–control study. Pharmacoepidemiol Drug Safety. 1992, 1: 65-72.CrossRef Nobili A, Mosconi P, Franzosi MG, Tognoni G: Non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding, a post-marketing surveillance case–control study. Pharmacoepidemiol Drug Safety. 1992, 1: 65-72.CrossRef
22.
Zurück zum Zitat Langman M, Weil J, Wainwright P, Lawson DH, Rawlins MD, Logan RF, Murphy M, Vessey MP, Colin-Jones D: Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994, 343: 1075-1078. 10.1016/S0140-6736(94)90185-6.CrossRef Langman M, Weil J, Wainwright P, Lawson DH, Rawlins MD, Logan RF, Murphy M, Vessey MP, Colin-Jones D: Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. Lancet. 1994, 343: 1075-1078. 10.1016/S0140-6736(94)90185-6.CrossRef
23.
Zurück zum Zitat Rahme E, Pettitt D, LeLorier J: Dose–response curves with time dependent exposure: the case of acetaminophen gastrointestinal side effects [abstract]. Pharmacoepidemiol Drug Safety. 2000, 9: S104- Rahme E, Pettitt D, LeLorier J: Dose–response curves with time dependent exposure: the case of acetaminophen gastrointestinal side effects [abstract]. Pharmacoepidemiol Drug Safety. 2000, 9: S104-
24.
Zurück zum Zitat Hansen JM, Hallas J, M LJ, Bytzer P: Non-steroidal anti-inflammatory drugs and ulcer complications: a risk factor analysis for clinical decision-making. Scand J Gastroenterol. 1996, 31: 126-130.CrossRef Hansen JM, Hallas J, M LJ, Bytzer P: Non-steroidal anti-inflammatory drugs and ulcer complications: a risk factor analysis for clinical decision-making. Scand J Gastroenterol. 1996, 31: 126-130.CrossRef
25.
Zurück zum Zitat García Rodríguez LA, Walker AM, Pérez Gutthann S: Non-steroidal anti-inflammatory drugs and gastrointestinal hospitalizations in Saskatchewan: a cohort study. Epidemiology. 1992, 3: 337-342.CrossRef García Rodríguez LA, Walker AM, Pérez Gutthann S: Non-steroidal anti-inflammatory drugs and gastrointestinal hospitalizations in Saskatchewan: a cohort study. Epidemiology. 1992, 3: 337-342.CrossRef
26.
Zurück zum Zitat Lanza LL, Walker AM, Bortnichack EA, Dreyer NA: Peptic ulcer and gastrointestinal hemorrhage associated with non-steroidal anti-inflammatory drug use in patients younger than 65 years. A large health maintenance organization cohort study. Arch Internal Med. 1995, 155: 1371-1377. 10.1001/archinte.155.13.1371.CrossRef Lanza LL, Walker AM, Bortnichack EA, Dreyer NA: Peptic ulcer and gastrointestinal hemorrhage associated with non-steroidal anti-inflammatory drug use in patients younger than 65 years. A large health maintenance organization cohort study. Arch Internal Med. 1995, 155: 1371-1377. 10.1001/archinte.155.13.1371.CrossRef
Metadaten
Titel
The risk of upper gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents
verfasst von
Luis Alberto García Rodríguez
Sonia Hernández-Díaz
Publikationsdatum
01.01.2001
Verlag
BioMed Central
Erschienen in
Arthritis Research & Therapy / Ausgabe 2/2001
Elektronische ISSN: 1478-6362
DOI
https://doi.org/10.1186/ar146

Weitere Artikel der Ausgabe 2/2001

Arthritis Research & Therapy 2/2001 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Bei Herzinsuffizienz muss „Eisenmangel“ neu definiert werden!

16.05.2024 Herzinsuffizienz Nachrichten

Bei chronischer Herzinsuffizienz macht es einem internationalen Expertenteam zufolge wenig Sinn, die Diagnose „Eisenmangel“ am Serumferritin festzumachen. Das Team schlägt vor, sich lieber an die Transferrinsättigung zu halten.

Herzinfarkt mit 85 – trotzdem noch intensive Lipidsenkung?

16.05.2024 Hypercholesterinämie Nachrichten

Profitieren nach einem akuten Myokardinfarkt auch Betroffene über 80 Jahre noch von einer intensiven Lipidsenkung zur Sekundärprävention? Um diese Frage zu beantworten, wurden jetzt Registerdaten aus Frankreich ausgewertet.

ADHS-Medikation erhöht das kardiovaskuläre Risiko

16.05.2024 Herzinsuffizienz Nachrichten

Erwachsene, die Medikamente gegen das Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom einnehmen, laufen offenbar erhöhte Gefahr, an Herzschwäche zu erkranken oder einen Schlaganfall zu erleiden. Es scheint eine Dosis-Wirkungs-Beziehung zu bestehen.

Erstmanifestation eines Diabetes-Typ-1 bei Kindern: Ein Notfall!

16.05.2024 DDG-Jahrestagung 2024 Kongressbericht

Manifestiert sich ein Typ-1-Diabetes bei Kindern, ist das ein Notfall – ebenso wie eine diabetische Ketoazidose. Die Grundsäulen der Therapie bestehen aus Rehydratation, Insulin und Kaliumgabe. Insulin ist das Medikament der Wahl zur Behandlung der Ketoazidose.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.