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Nonsteroidal Anti-inflammatory Drug Use and Increased Risk for Peptic Ulcer Disease in Elderly Persons

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

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

Requests for Reprints: Marie R. Griffin, MD, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2637.

Current Author Addresses: Drs. Griffin, Piper, and Ray, Mr. Daugherty, and Ms. Snowden: Department of Preventive Medicine, Vanderbilt UniversitySchool of Medicine, Nashville, TN 37232-2637.

© 1991 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1991;114(4):257-263. doi:10.7326/0003-4819-114-4-257
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Objective: To evaluate the relative risk for peptic ulcer disease that is associated with the use of nonaspirin nonsteroidal anti-inflammatorydrugs.

Design: Nested case-control study.

Setting: Tennessee Medicaid program.

Participants: Medicaid enrollees 65 years of age or older were included in the study. The 1415 case patients had been hospitalized for confirmed peptic ulcer disease at some point from 1984 through 1986. The 7063 control persons represented a stratified random sample of other Medicaid enrollees.

Measurements and Main Results: The estimated relative risk for the development of peptic ulcer disease among current users of nonaspirin nonsteroidal anti-inflammatory drugs, compared with that among nonusers, was 4.1 (95% CI, 3.5 to 4.7). For current users, the risk increased with increasing dose, from a relative risk of 2.8 (CI, 1.8 to 4.3) for the lowest to a relative risk of 8.0 (CI, 4.4 to 14.8) for the highest dose category. The risk was greatest in the first month of use (relative risk, 7.2; CI, 4.9 to 10.5). If the association is fully causal, 29% of peptic ulcers in the study sample resulted from the use of these drugs, and the excess risk associated with such use was 17.4 hospitalizations for ulcer disease per 1000 person-years of exposure.

Conclusions: These data support other findings indicating that a clinically significant risk for serious ulcer disease is associated with the use of nonaspirin nonsteroidal anti-inflammatory drugs. The data show that this risk increases with dose and recency of use and that use of these drugs may be responsible for a large proportion of peptic ulcer disease among elderly persons.





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