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Major Upper Gastrointestinal Tract Bleeding: Relation to the Use of Aspirin and Other Nonnarcotic Analgesics

Major Upper Gastrointestinal Tract Bleeding: Relation to the Use of Aspirin and Other Nonnarcotic... Abstract • In a hospital-based case-control study, the risk of a first episode of major upper gastrointestinal tract bleeding in subjects now known to be predisposed was assessed in relation to the use of nonnarcotic analgesics. For aspirin use within the week before the onset of symptoms, the rate ratio estimates, adjusted for potential confounding, were 15 (95% confidence interval, 6.4 to 34) for regular use (at least four days a week) and 5.6 (confidence interval, 2.7 to 12) for occasional use. For aspirin use discontinued at least one week earlier, the estimate was 1.6 (confidence interval, 0.6 to 4.2). There was no evidence that acetaminophen use increased the risk. For the regular use of other analgesics in the week before onset, the adjusted rate ratio estimate was 9.1 (confidence interval, 2.7 to 31); there were insufficient data to evaluate occasional use. The findings suggest that the risk of bleeding is increased substantially by aspirin, even when used occasionally. With the exception of acetaminophen, other nonnarcotic analgesics may also increase the risk, but they remain to be evaluated individually. (Arch Intern Med 1988;148:281-285) References 1. Douthwaite AH: Some recent advances in medical diagnosis and treatment. Br Med J 1938;1:1143.Crossref 2. Hurst A, Lintott GAM: Aspirin as a cause of hematemesis. Guys Hosp Rep 1939;89:173. 3. Jolobe OMP, Montgomery RD: Changing patterns of gastric ulcer: Are anti-inflammatory drugs involved? Digestion 1981;29:164-170.Crossref 4. Cardoe N, Fowler PD: Butacote: A six-year follow-up of patients with gastric intolerance to other medications. J Int Med Res 1977;2( (suppl 5) ):59. 5. Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics , ed 5. New York, MacMillan Publishing Co Inc, 1975. 6. Ivey KJ: Gastrointestinal effects of antipyretic analgesics. Am J Med 1983;75( (5A) ):53-64.Crossref 7. Levy M: Epidemiological evaluation of rare side effects of mild analgesics. Br J Clin Pharmacol 1980;10:395S-399S.Crossref 8. Shirley E: A review of papers purporting to show a cause-and-effect relationship between aspirin ingestion and massive gastrointestinal hemorrhage. Proc R Soc Med 1977;70:4-10. 9. Langman, MJS: Epidemiological evidence for the association of aspirin and acute gastrointestinal bleeding. Gut 1970;11:627-634.Crossref 10. Rees WD, Turnberg LA: Reappraisal of the effects of aspirin on the stomach. Lancet 1980;2:410-413.Crossref 11. Kurata JH, Elashoff JD, Grossman MI: Inadequacy of the literature on the relationship between drugs, ulcers and gastrointestinal bleeding. Gastroenterology 1982;82:373-382. 12. Slone D, Shapiro S, Miettinen OS: Case-control surveillance of serious illnesses attributable to ambulatory drug use , in Colombo F, Shapiro S, Slone D, et al (eds): Epidemiological Evaluation of Drugs . Amsterdam, Elsevier North-Holland Biomedical Press, 1977, pp 59-70. 13. Miettinen OS: Estimability and estimation in case-reference studies. Am J Epidemiol 1976;103:226-235. 14. Armitage P: Statistical Methods in Medical Research . New York, John Wiley & Sons Inc, 1977, p 380. 15. Anderson JA: Separate sample logistic discrimination. Biometrika 1972;58:19-35.Crossref 16. Levy M: Aspirin use in patients with major upper gastrointestinal bleeding and peptic ulcer disease. N Engl J Med 1974;290:1158-1162.Crossref 17. Coggon D, Langman MJS, Spiegelhalter D: Aspirin, paracetamol and haematemesis and melena. Gut 1982;23:340-344.Crossref 18. Crook JN, Gray LW, Nance FC, et al: Upper gastrointestinal bleeding. Ann Surg 1972;175:771-782.Crossref 19. Leonards JR, Levy G, Niemczura R: Gastrointestinal blood loss during prolonged aspirin administration. N Engl J Med 1973;289:1020-1022. 20. Whittle BJ, Vane JR: A biochemical basis for the gastrointestinal toxicity of non-steroid antirheumatoid drugs. Arch Toxicol Suppl 1984;7:315-322. 21. Brown RK, Mitchell N: The influence of some of the salicyl compounds (and alcoholic beverages) on the natural history of peptic ulcer. Gastroenterology 1956;31:198-203. 22. Kelly JJ, Jr: Salicylate ingestion: A frequent cause of gastric hemorrhage. Am J Med Sci 1956;232:119-128.Crossref 23. Lange HF: Salicylates and gastric hemorrhage: I. Occult bleeding. II. Manifest bleeding. Gastroenterology 1957;33:770-788. 24. Alvarez AS, Summerskill WHJ: Gastrointestinal haemorrhage and salicylates. Lancet 1958;2:920-925.Crossref 25. Allibone A, Flint FJ: Bronchitis, aspirin, smoking and other factors in the aetiology of peptic ulcer. Lancet 1958;2:179-182.Crossref 26. Muir A, Cossar IA: Aspirin and gastric haemorrhage. Lancet 1959;1:539-541.Crossref 27. Jennings GH: Casual influences in hematemesis and melena. Gut 1965;6:1-13.Crossref 28. Astley CE: Gastritis, aspirin and alcohol. Br M ed J 1967;4:484.Crossref 29. Parry DJ, Wood PHN: Relationship between aspirin taking and gastroduodenal haemorrhage. Gut 1967;8:301-307.Crossref 30. Valman HB, Parry DJ, Coghill NF: Lesions associated with gastroduodenal haemorrhage in relation to aspirin intake. Br Med J 1968;4:661-663.Crossref 31. Needham CD, Kyle J, Jones PF, et al: Aspirin and alcohol in gastrointestinal haemorrhage. Gut 1971;12:819-821.Crossref 32. Belcon MD, Rooney PJ, Tugwell P: Aspirin and gastrointestinal haemorrhage: A methodologic assessment. J Chronic Dis 1985;38:101-111.Crossref 33. Schiller KFR, Truelove SC, Williams DG: Hematemesis and melena with special reference to factors influencing the outcome. Br Med J 1980;11:7-24. 34. Allan R, Dykes P: A study of the factors influencing mortality rates from gastrointestinal hemorrhage. Q J Med 1976;45:533. 35. Morgan AG, McAdam WAF, Walmsley GL, et al: Clinical findings, early endoscopy and multivariate analysis in patients bleeding from the upper gastrointestinal tract. Br Med J 1977;2:237-240.Crossref 36. Katon RM, Smith FW: Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. Gastroenterology 1983;65:728-734. 37. American Hospital Association: AHA Guide to the Health Care Field: 1972 . Chicago, American Hospital Association, 1973. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Major Upper Gastrointestinal Tract Bleeding: Relation to the Use of Aspirin and Other Nonnarcotic Analgesics

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Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380020025005
Publisher site
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Abstract

Abstract • In a hospital-based case-control study, the risk of a first episode of major upper gastrointestinal tract bleeding in subjects now known to be predisposed was assessed in relation to the use of nonnarcotic analgesics. For aspirin use within the week before the onset of symptoms, the rate ratio estimates, adjusted for potential confounding, were 15 (95% confidence interval, 6.4 to 34) for regular use (at least four days a week) and 5.6 (confidence interval, 2.7 to 12) for occasional use. For aspirin use discontinued at least one week earlier, the estimate was 1.6 (confidence interval, 0.6 to 4.2). There was no evidence that acetaminophen use increased the risk. For the regular use of other analgesics in the week before onset, the adjusted rate ratio estimate was 9.1 (confidence interval, 2.7 to 31); there were insufficient data to evaluate occasional use. The findings suggest that the risk of bleeding is increased substantially by aspirin, even when used occasionally. With the exception of acetaminophen, other nonnarcotic analgesics may also increase the risk, but they remain to be evaluated individually. (Arch Intern Med 1988;148:281-285) References 1. Douthwaite AH: Some recent advances in medical diagnosis and treatment. Br Med J 1938;1:1143.Crossref 2. Hurst A, Lintott GAM: Aspirin as a cause of hematemesis. Guys Hosp Rep 1939;89:173. 3. Jolobe OMP, Montgomery RD: Changing patterns of gastric ulcer: Are anti-inflammatory drugs involved? Digestion 1981;29:164-170.Crossref 4. Cardoe N, Fowler PD: Butacote: A six-year follow-up of patients with gastric intolerance to other medications. J Int Med Res 1977;2( (suppl 5) ):59. 5. Goodman LS, Gilman A: The Pharmacological Basis of Therapeutics , ed 5. New York, MacMillan Publishing Co Inc, 1975. 6. Ivey KJ: Gastrointestinal effects of antipyretic analgesics. Am J Med 1983;75( (5A) ):53-64.Crossref 7. Levy M: Epidemiological evaluation of rare side effects of mild analgesics. Br J Clin Pharmacol 1980;10:395S-399S.Crossref 8. Shirley E: A review of papers purporting to show a cause-and-effect relationship between aspirin ingestion and massive gastrointestinal hemorrhage. Proc R Soc Med 1977;70:4-10. 9. Langman, MJS: Epidemiological evidence for the association of aspirin and acute gastrointestinal bleeding. Gut 1970;11:627-634.Crossref 10. Rees WD, Turnberg LA: Reappraisal of the effects of aspirin on the stomach. Lancet 1980;2:410-413.Crossref 11. Kurata JH, Elashoff JD, Grossman MI: Inadequacy of the literature on the relationship between drugs, ulcers and gastrointestinal bleeding. Gastroenterology 1982;82:373-382. 12. Slone D, Shapiro S, Miettinen OS: Case-control surveillance of serious illnesses attributable to ambulatory drug use , in Colombo F, Shapiro S, Slone D, et al (eds): Epidemiological Evaluation of Drugs . Amsterdam, Elsevier North-Holland Biomedical Press, 1977, pp 59-70. 13. Miettinen OS: Estimability and estimation in case-reference studies. Am J Epidemiol 1976;103:226-235. 14. Armitage P: Statistical Methods in Medical Research . New York, John Wiley & Sons Inc, 1977, p 380. 15. Anderson JA: Separate sample logistic discrimination. Biometrika 1972;58:19-35.Crossref 16. Levy M: Aspirin use in patients with major upper gastrointestinal bleeding and peptic ulcer disease. N Engl J Med 1974;290:1158-1162.Crossref 17. Coggon D, Langman MJS, Spiegelhalter D: Aspirin, paracetamol and haematemesis and melena. Gut 1982;23:340-344.Crossref 18. Crook JN, Gray LW, Nance FC, et al: Upper gastrointestinal bleeding. Ann Surg 1972;175:771-782.Crossref 19. Leonards JR, Levy G, Niemczura R: Gastrointestinal blood loss during prolonged aspirin administration. N Engl J Med 1973;289:1020-1022. 20. Whittle BJ, Vane JR: A biochemical basis for the gastrointestinal toxicity of non-steroid antirheumatoid drugs. Arch Toxicol Suppl 1984;7:315-322. 21. Brown RK, Mitchell N: The influence of some of the salicyl compounds (and alcoholic beverages) on the natural history of peptic ulcer. Gastroenterology 1956;31:198-203. 22. Kelly JJ, Jr: Salicylate ingestion: A frequent cause of gastric hemorrhage. Am J Med Sci 1956;232:119-128.Crossref 23. Lange HF: Salicylates and gastric hemorrhage: I. Occult bleeding. II. Manifest bleeding. Gastroenterology 1957;33:770-788. 24. Alvarez AS, Summerskill WHJ: Gastrointestinal haemorrhage and salicylates. Lancet 1958;2:920-925.Crossref 25. Allibone A, Flint FJ: Bronchitis, aspirin, smoking and other factors in the aetiology of peptic ulcer. Lancet 1958;2:179-182.Crossref 26. Muir A, Cossar IA: Aspirin and gastric haemorrhage. Lancet 1959;1:539-541.Crossref 27. Jennings GH: Casual influences in hematemesis and melena. Gut 1965;6:1-13.Crossref 28. Astley CE: Gastritis, aspirin and alcohol. Br M ed J 1967;4:484.Crossref 29. Parry DJ, Wood PHN: Relationship between aspirin taking and gastroduodenal haemorrhage. Gut 1967;8:301-307.Crossref 30. Valman HB, Parry DJ, Coghill NF: Lesions associated with gastroduodenal haemorrhage in relation to aspirin intake. Br Med J 1968;4:661-663.Crossref 31. Needham CD, Kyle J, Jones PF, et al: Aspirin and alcohol in gastrointestinal haemorrhage. Gut 1971;12:819-821.Crossref 32. Belcon MD, Rooney PJ, Tugwell P: Aspirin and gastrointestinal haemorrhage: A methodologic assessment. J Chronic Dis 1985;38:101-111.Crossref 33. Schiller KFR, Truelove SC, Williams DG: Hematemesis and melena with special reference to factors influencing the outcome. Br Med J 1980;11:7-24. 34. Allan R, Dykes P: A study of the factors influencing mortality rates from gastrointestinal hemorrhage. Q J Med 1976;45:533. 35. Morgan AG, McAdam WAF, Walmsley GL, et al: Clinical findings, early endoscopy and multivariate analysis in patients bleeding from the upper gastrointestinal tract. Br Med J 1977;2:237-240.Crossref 36. Katon RM, Smith FW: Panendoscopy in the early diagnosis of acute upper gastrointestinal bleeding. Gastroenterology 1983;65:728-734. 37. American Hospital Association: AHA Guide to the Health Care Field: 1972 . Chicago, American Hospital Association, 1973.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1988

References