Risk of uncomplicated peptic ulcer among users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs.
American Journal of Epidemiology 2004;159:23-31
ABSTRACT
The association between non-steroidal anti-inflammatory drugs (NSAIDs) and upper gastrointestinal complications is well documented. However, epidemiologic data on the risk of clinically symptomatic but uncomplicated peptic ulcer is quite limited. The authors studied the association between prescription NSAIDs and the risk of symptomatic ulcer in a population-based cohort of 458,840 persons and 1,167,469 person-years in the United Kingdom between 1995 and 1999, and conducted a nested case-control analysis of 1,197 cases and 10,000 controls. Relative risk (RR) and 95% confidence intervals (CI) were estimated and adjusted for several factors known to be associated with gastrointestinal damage. The incidence rate of symptomatic ulcer was 1.03 (95%CI, 0.97-1.08) cases per 1,000 person-years. Compared with non-users, the RR was 2.9 (95%CI, 2.3-3.6) for aspirin and 4.0 (95%CI, 3.2-5.1) for non-aspirin NSAID users. For aspirin users, the RR was similar for doses up to 300 mg daily and for both gastric and duodenal ulcers. For non-aspirin NSAIDs, the RR was 2.6 (95% CI, 2.0-3.5) for medium daily doses or lower and 4.9 (95% CI, 3.8-6.5) for high daily doses; it was 5.6 (95% CI, 3.9-8.2) for gastric and 3.1 (95% CI, 2.3-4.2) for duodenal ulcers. The risk of symptomatic ulcer for aspirin and non-aspirin NSAIDs was elevated throughout treatment. These findings suggest that NSAIDs might not only complicate but also originate clinically relevant peptic ulcers.