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J Gastroenterol. 2010 Sep;45(9):944-51. doi: 10.1007/s00535-010-0236-2. Epub 2010 May 25.

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.

Author information

1
Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.

Abstract

OBJECTIVE:

Recently, guidelines for the treatment and prevention of ulcers induced by non-steroidal anti-inflammatory drugs (NSAIDs) were established. This study investigated the association between the current adherence to the guidelines and the incidence of gastric mucosal lesions caused by NSAIDs.

METHODS:

This study included 254 NSAIDs users (128 regular and 126 on-demand users) who had undergone upper gastrointestinal endoscopy. The patients were characterized as high risk based on the following: age 65 years or older, history of peptic ulcers, concurrent use of corticosteroids or anticoagulants, and high-dose NSAIDs use. Adherence was defined as the prescription of NSAIDs with proton pump inhibitors, prostaglandin analogues, or high-dose histamine 2 receptor antagonists in high-risk NSAIDs user. The severity of gastric mucosal lesions was evaluated using the modified LANZA score (MLS).

RESULTS:

Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of the on-demand NSAIDs users met our definition of high-risk patients. Adherence in the regular NSAIDs users and on-demand NSAIDs users was 25 (31.7%) and 16 (24.6%), respectively. The incidence of gastric mucosal lesions (MLS ≧ 1) was significantly higher in the nonadherence group than in the adherence group for both regular NSAIDs users (59.3 vs. 28.0%, P = 0.01) and on-demand NSAIDs users (63.3 vs. 25.0%, P = 0.01). Gastric ulcers in the regular NSAIDs users were more frequently observed in the nonadherence group than in the adherence group (29.6 vs. 4.0%, P < 0.01).

CONCLUSION:

Nonadherence was associated with a high prevalence of NSAIDs-induced gastric mucosal lesions.

PMID:
20499110
DOI:
10.1007/s00535-010-0236-2
[Indexed for MEDLINE]

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