The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Corticosteroid Use and Peptic Ulcer Disease: Role of Nonsteroidal Anti-inflammatory Drugs

Joyce M. Piper, DrPH; Wayne A. Ray, PhD; James R. Daugherty, MS; and Marie R. Griffin, MD, MPH
[+] Article, Author, and Disclosure Information

Grant Support: In part by Cooperative Agreement FD-U-000073 from the Food and Drug Administration. Dr. Griffin is a Burroughs Wellcome Scholar in Pharmacoepidemiology.

Requests for Reprints: Joyce M. Piper, DrPH, Department of Preventive Medicine, Vanderbilt University School of Medicine, Medical Center North A-1112, Nashville, TN 37232-2637.

Current Author Addresses: Drs. Piper, Ray, and Griffin, and Mr. Daugherty: Department of Preventive Medicine, Vanderbilt University School of Medicine, Medical Center North A-1112, Nashville, TN 37232-2637.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(9):735-740. doi:10.7326/0003-4819-114-9-735
Text Size: A A A

Objective: To estimate the relative risk for peptic ulcer disease that is associated with the use of oral corticosteroids.

Design: A nested case-control study.

Setting: Tennessee Medicaid program.

Participants: The case patients (n = 1415) were hospitalized between 1984 and 1986 for gastric or duodenal ulcer or for upper gastrointestinal hemorrhage of unknown cause. The controls (n = 7063) were randomly selected from Medicaid enrollees not meeting the study criteria for inclusion as case patients.

Measurements and Main Results: The estimated relative risk for the development of peptic ulcer disease among current users of oral corticosteroids was 2.0 (95% CI, 1.3 to 3.0). However, the risk was increased only in those who concurrently received nonsteroidal anti-inflammatory drugs (NSAIDs); these persons had an estimated relative risk associated with current corticosteroid use of 4.4 (CI, 2.0 to 9.7). In contrast, the estimated relative risk for those corticosteroid users not receiving NSAIDs was 1.1 (CI, 0.5 to 2.1). Persons concurrently receiving corticosteroids and NSAIDs had a risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug.

Conclusion: Discrepant findings among earlier studies regarding steroids and the risk for peptic ulcer disease could in part be due to differences in the use of NSAIDs among study participants. The high risk for peptic ulcer disease associated with combined use of NSAIDs and corticosteroids indicates the need to prescribe this drug combination cautiously.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.