Online citations, reference lists, and bibliographies.

The Relative Efficacies Of Gastroprotective Strategies In Chronic Users Of Nonsteroidal Anti-inflammatory Drugs.

Laura E Targownik, Colleen J. Metge, Stella Leung, Daniel G Chateau
Published 2008 · Medicine
Cite This
Download PDF
Analyze on Scholarcy
BACKGROUND & AIMS There are numerous gastroprotective strategies recommended for reducing the risk of upper gastrointestinal (GI) complications in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs). The relative efficacy of the different strategies alone or in combination is uncertain. METHODS We used the Manitoba Population Health Research Data Repository to perform a population-based matched case-control analysis. All NSAID users (nonselective and cyclooxygenase [COX]-2-specific) users admitted to the hospital with a primary diagnosis for an upper gastrointestinal complication were matched to NSAID-using controls in the community. We used conditional logistic regression analysis to determine the relative efficacy of different gastroprotective strategies (proton pump inhibitors [PPIs], COX-2 inhibitors, and low-dose/high-dose misoprostol) either alone or in combination and to adjust for multiple pertinent covariates. RESULTS A total of 1382 NSAID/COX-2 users with upper GI complications were matched to 33,957 age- and sex-matched controls. Cotherapy with PPIs or misoprostol or use of a COX-2 inhibitor all significantly reduced the risk of upper GI complications. COX-2 inhibitors were not statistically more likely to prevent upper GI complications than PPIs, although they were superior to low-dose misoprostol. The combination of COX-2 inhibitors with a PPI was associated with the greatest degree of upper GI complication risk reduction. CONCLUSIONS All of the commonly accepted gastroprotective strategies reduce the risk of upper GI complications in NSAID users, although the combination of COX-2 inhibitors with PPIs promotes the greatest risk reduction for NSAID-related upper GI complications. Celecoxib use specifically may be superior to the combination of nonselective NSAIDs with a PPI.
This paper references
Evidence of aspirin use in both upper and lower gastrointestinal perforation.
Ángel Lanas (1997)
Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs
M. S. Langman (1994)
Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study.
Elham Rahme (2006)
Revisiting the Manitoba Centre for Health Policy and Evaluation and its population-based health information system.
N. Roos (1999)
Celecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications.
K. Lai (2005)
Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group.
C. Bombardier (2000)
Positive Predictive Value of ICD‐9 Codes in the Identification of Cases of Complicated Peptic Ulcer Disease in the Saskatchewan Hospital Automated Database
Drusilla S. Raiford (1996)
Combination of a cyclo-oxygenase-2 inhibitor and a proton-pump inhibitor for prevention of recurrent ulcer bleeding in patients at very high risk: a double-blind, randomised trial
F. L. Chan (2007)
Chapter 5: Arthritis-related prescription medications
N Kasman (2007)
The population's use of pharmaceuticals.
C. Metge (1999)
Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.
M. Griffin (1991)
Superiority of lansoprazole vs ranitidine in healing nonsteroidal anti-inflammatory drug-associated gastric ulcers: results of a double-blind, randomized, multicenter study. NSAID-Associated Gastric Ulcer Study Group.
Naurang M. Agrawal (2000)
The Prevalence of and the Clinical and Demographic Characteristics Associated With High-Intensity Proton Pump Inhibitor Use
Laura E Targownik (2007)
Risk of upper gastrointestinal bleeding and perforation associated with Individual non-steroidal anti-inflammatory drugs
L. G. Rodríguez (1994)
Comparison of the upper gastrointestinal safety of Arthrotec 75 and nabumetone in osteoarthritis patients at high risk for developing nonsteroidal anti-inflammatory drug-induced gastrointestinal ulcers.
Naurang M. Agrawal (1999)
Diclofenac/misoprostol compared with diclofenac in the treatment of osteoarthritis of the knee or hip: a randomized, placebo controlled trial. Arthrotec Osteoarthritis Study Group.
Tomás S. Bocanegra (1998)
Risk of peptic ulcer hospitalizations in users of NSAIDs with gastroprotective cotherapy versus coxibs.
W. A. Ray (2007)
Ambulatory care groups: a categorization of diagnoses for research and management.
B. Starfield (1991)
Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs.
R. Laheij (2004)
Use of pharmaceuticals by inflammatory bowel disease patients: a population-based study
Colleen J. Metge (2001)
Diagnosing asthma: the fit between survey and administrative database.
Lisa L. Huzel (2002)
Misoprostol and ranitidine in the prevention of NSAID-induced ulcers: a prospective, double-blind, multicenter study.
J. Raskin (1996)
A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal antiinflammatory drugs. Acid Suppression Trial: Ranitidine versus Omeprazole for NSAID-associated Ulcer Treatment (ASTRONAUT) Study Group.
N. Yeomans (1998)
Consensus development conference on the use of nonsteroidal anti-inflammatory agents, including cyclooxygenase-2 enzyme inhibitors and aspirin.
C. Wilcox (2006)
The accuracy of diagnosis and procedural codes for patients with upper GI hemorrhage.
G. Cooper (2000)
Establishing a population data-based policy unit.
N. Roos (1999)
Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial.
R. Bresalier (2005)
Estimating the burden of disease. Comparing administrative data and self-reports.
J. R. Robinson (1997)
An evidence-based approach to prescribing nonsteroidal antiinflammatory drugs. Third Canadian Consensus Conference.
H. Tannenbaum (2006)
Misoprostol Reduces Serious Gastrointestinal Complications in Patients with Rheumatoid Arthritis Receiving Nonsteroidal Anti-Inflammatory Drugs
F. Silverstein (1995)
Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease
S. Dial (2005)
Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study.
F. Silverstein (2000)
Trends in management and outcomes of acute nonvariceal upper gastrointestinal bleeding: 1993-2003.
L. Targownik (2006)
Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial.
F. Chan (2004)
Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy
S. Dial (2006)
Omeprazole Compared with Misoprostol for Ulcers Associated with Nonsteroidal Antiinflammatory Drugs
C. Hawkey (1998)
Celecoxib Versus Diclofenac and Omeprazole in Reducing the Risk of Recurrent Ulcer Bleeding in Patients With Arthritis
C. Bailey (2003)
Complications of the COX-2 Inhibitors Parecoxib and Valdecoxib After Cardiac Surgery
N. Nussmeier (2005)
Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial
T. Schnitzer (2004)
Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis.
S. Gabriel (1991)
Long-term proton pump inhibitor therapy and risk of hip fracture.
Yu-Xiao Yang (2006)
Cardiovascular Risk Associated With Celecoxib in a Clinical Trial for Colorectal Adenoma Prevention
S. Solomon (2005)

This paper is referenced by
Effects of prednisone alone or prednisone with ultralow-dose aspirin on the gastroduodenal mucosa of healthy dogs.
A Heather Graham (2009)
Are the clinical guideline recommendations on gastroprotection being followed? A review in patients taking nonsteroidal anti-inflammatory drugs.
José A. Velasco-Zamora (2016)
Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer
Young-Il Kim (2015)
Combination therapy versus celecoxib, a single selective COX-2 agent, to reduce gastrointestinal toxicity in arthritic patients: patient and cost-effectiveness considerations
Marina Scolnik (2011)
7 Chronic NSAIDs Therapy and Upper Gastrointestinal Tract – Mechanism of Injury , Mucosal Defense , Risk Factors for Complication Development and Clinical Management
Francesco Azzaroli (2012)
¿Qué tanto se siguen las recomendaciones de las guías clínicas sobre gastroprotección? Una revisión en enfermos que consumen antiinflamatorios no esteroideos
José A. Velasco-Zamora (2016)
NSAIDs, risks, and gastroprotective strategies: current status and future.
D. Graham (2008)
Knowledge and Attitudes of Internal Medicine Trainees' Co-Prescribing Patterns of Gastroprotective Agents in Patients Taking Long-Term Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Duong Nikki (2018)
비스테로이드소염제 관련 소화성 궤양의 최신지견
최동욱 (2014)
Reações adversas gastrointestinais: causas, prevenção e tratamento
Alexandra Cristina Neves Pargana (2015)
A wider view on gastric erosion: detailed evaluation of complex somatic and behavioral changes in rats treated with indomethacin at gastric ulcerogenic dose.
Ludmila Filaretova (2014)
Effects and Prevention of Chronic NSAID Use on the Stomach
Martha K. Braun (2008)
Characterization of mechanisms underlying the effects of esomeprazole on the impairment of gastric ulcer healing with addition of NSAID treatment.
R. Colucci (2009)
Gastric Acid Secretions, Treatments, and Nutritional Consequences
Ronit Zilberboim (2010)
Philippine Consensus Statements on the Management Of Non-Variceal Upper Gastrointestinal Bleeding: 2012
Jose D. Sollano (2012)
Mitigating GI risks associated with the use of NSAIDs.
Mahnaz Momeni (2013)
Suppression of Hypothalamo-Hypophyseal-Adrenocortical System Function as the Cause of Aggravation of the Ulcerogenic Action of Indomethacin on the Stomach after Administration of Pharmacological Doses of Hydrocortisone
O. Yu. Morozova (2009)
Obtaining of sol-gel ketorolac-silica nanoparticles: characterization and drug release kinetics
Tessy López Goerne (2013)
Pain in Urology: The Good, the Bad, and the Ugly
Jan H. Vranken (2014)
Histopathology and oxidative stress analysis of concomitant misoprostol and celecoxib administration
Derek E. Murrell (2015)
Gastro-protective strategies in primary care in Italy: the "Gas.Pro." survey.
Maria A. Bianco (2010)
ce dyspepsia and peptic ulcer disease: Clinical pathophysiology and current management
Brian Bartle (2010)
Association between adherence to evidence-based guidelines for the prescription of non-steroidal anti-inflammatory drugs and the incidence of gastric mucosal lesions in Japanese patients
Hidetaka Tsumura (2010)
Comparison of safety, efficacy and tolerability of Dexibuprofen and Ibuprofen in the treatment of osteoarthritis of the hip or knee
Omid Zamani (2014)
Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs in Maxillofacial Trauma Patients: A Review
Santosh Yadav (2012)
Colin J Crooks (2013)
Therapeutic Management of Recurrent Peptic Ulcer Disease
Raymond Shing Yan Tang (2012)
geschützt werden ? NSAIDs , Coxibs and Steroids : When and How to Protect the Stomach and Intestine
Manfred (2018)
Management of Nonvariceal Upper Gastrointestinal Bleeding
Sobia A Zuberi (2010)
Antinociception by fluoro‐loxoprofen, a novel non‐steroidal anti‐inflammatory drug with less ulcerogenic effects, in rat models of inflammatory pain
Teita Asano (2019)
Omega-3 polyunsaturated fatty acids as an angelus custos to rescue patients from NSAID-induced gastroduodenal damage
J. Park (2014)
Indications and safety of proton pump inhibitor drug use in patients with cancer
George Triadafilopoulos (2013)
See more
Semantic Scholar Logo Some data provided by SemanticScholar