Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

Abstract

Background and purposeClinical guidelines recommend the prescribing of gastroprotective strategies in nonsteroidal anti-inflammatory drug (NSAID) users with risk factors for gastrointestinal (GI) ulcer or ulcer complications. However, these guidelines are not often translated into clinical practice. Therefore, the aim of this study was to investigate the utilization of gastroprotective strategies for NSAID-induced upper GI events in at-risk users in a major teaching hospital.Patients and methodsA cross-sectional, observational, pharmacy-based study was conducted in a major Asian institution with both primary and secondary health care services. This study involved the screening of prescriptions for regular NSAIDs, and patients who met the inclusion criteria were recruited and interviewed using a questionnaire.ResultsOf the 409 participants recruited, 83.1% had at least one GI risk factor, of whom 70.3% did not receive appropriate gastroprotection. The most common GI risk factor was the use of high-dose NSAIDs (69.2%), followed by participants aged 65 years and older (22%) and concomitant use of low-dose aspirin (11.7%). Appropriate gastroprotective strategies utilized consisted of the use of a cyclooxygenase (COX)-2 inhibitor alone or a nonselective NSAID plus a proton pump inhibitor (PPI) in the moderate-risk group and a COX-2 inhibitor plus a PPI in the high-risk group. Gastroprotective strategies were underutilized in 67.1% of at-risk participants and overutilized in 59.4% of those without risk factors. Co-prescription of a histamine-2 receptor antagonist at lower-than-recommended doses constituted 59% of the inappropriate gastroprotective agents used. Logistic regression analysis revealed patients aged 65 years and older (odds ratio, 1.89; 95% CI =1.15–3.09) as a predictor for the prescribing of gastroprotection by the clinicians.ConclusionApproximately 70% of at-risk NSAID users, mainly on high-dose NSAIDs, were not prescribed appropriate gastroprotective strategies. Further measures are warranted to improve the safe prescribing of regular NSAIDs.

Gastroprotective Effect of Vanillin on Indomethacin-Induced Gastric Ulcer in Rats: Protective Pathways and Anti-Secretory Mechanism

“…are extensively used for their analgesic, anti-inflammatory and antipyretic properties. However, their administration is frequently associated with peptic ulcer induction [1]. Indomethacin is an important member of the NSAIDs family.…”

Dyspepsia in non‐steroidal anti‐inflammatory drug users and the effect of preventive measures

“…In addition, 60.6% of the participants were new users of NSAIDs, whereas the remaining were repeated users. The main indication for consuming regular NSAIDs among our subjects was musculoskeletal pain (48.4%) …”

“…Of the 449 patients who initially met the inclusion criteria, 36 refused to participate for various reasons. Another four patients subsequently had to be excluded as it was found that they did not meet the inclusion criteria . Therefore, the remaining 409 participants were included in the present study.…”

“…Since the four patients excluded later were not considered as non‐responders, the response rate was calculated based on 445 patients, giving a response rate of 91.9%. The characteristics of these participants and the NSAIDs prescribed are described in our previous article . The participants in this study aged 52.3 ± 14.6 years (range 21–83 years), including 248 women and 161 men.…”

“…A prospective, longitudinal study was conducted in a large teaching hospital. This was the continuation of a cross‐sectional study conducted to investigate the utilization of gastroprotective strategies in NSAID users with risk factors for gastrointestinal events . Patients who had been given prescriptions which contained regular NSAIDs at the Outpatient Pharmacy of the teaching hospital from April 2013 to May 2015 were requested to participate in the study via convenience sampling.…”