NSAIDs: increased the risk of upper GI bleeding, peptic ulcers or dying.

Clinical bottom line (level 2a)

Patients on NSAIDs were at increased risk of having upper GI bleeding, peptic ulcers or dying.

Bollini et al: Archives of Internal Medicine 1992; 152: 1289-1295

Expires November 2002

The study

Systematic review of cohort and case-control studies of

Patients: on non-steroidal anti-inflammatory drugs

Outcome: upper GI bleeding, peptic ulcer, ulcer perforation, death

Articles found in ?English using Medline, 1966 to 1990 (search terms: not stated ) and searching review articles and reference lists of selected articles

Selection criteria: detailed in text
Appraisal criteria: articles were scored using a quality checklist by two independent reviewers
Articles excluded if: not detailed

34 studies were found: 7 cohort studies, 8 case-control with community controls and 19 case-control with hospital controls
Studies were combined using a random-effects model. Cohort and hospital-based case-control studies were found to be significantly heterogeneous.

The evidence

pooled RR for GI bleeding, peptic ulcers or dying: 3.0 (95% CI: 1.9 to 4.7)
- RR for cohort studies: 2.0 (95% CI: 1.2 to 3.2)
- RR for hospital-based case-control studies: 4.4 (95% CI: 3.3 to 6.0)
- RR for community-based case-control: 3.5 (95% CI: 2.1 to 5.6)

Comments

Only 44% of studies adjusted for confounding factors and 11% of case-control studies were blinded.

Citation

Bollini P, Garcia Rodriguez LA, Perez Gutthann S, et al: The impact of research quality and study design on epidemiologic estimates of the effect of nonsteroidal anti-inflammatory drugs on upper gastrointestinal tract disease. Archives of Internal Medicine 1992; 152: 1289-1295

Contributor: Chris Ball and Clare Wotton, November 1999
Reviewer: Daniel Sontheimer

_{Clinical Question.}

_Patient	_adult
_{Intervention or Exposure}	_{on NSAIDs}
_Outcome	_{upper GI bleeding, ulcer, perforation or death}