J. Hallas et P. Bytzer, SCREENING FOR DRUG-RELATED DYSPEPSIA - AN ANALYSIS OF PRESCRIPTION SYMMETRY, European journal of gastroenterology & hepatology, 10(1), 1998, pp. 27-32
Objective Most patients with severe upper dyspepsia are treated empiri
cally with ulcer drugs. Drug-induced dyspepsia might therefore be refl
ected in the sequencing of ulcer drugs relative to other medications.
Our aim was to screen a large population-base prescription database fo
r evidence of drug-induced dyspepsia. Methods Prescription data on 31
232 incident users of ulcer drugs were drawn from a research database,
covering the county of Funen, Denmark. We identified all individuals
who had started their first recorded therapies with an ulcer drug and
another non-ulcer drug within a 100 day span. In this selected group,
there would normally be an equal number starting either drug first, wh
ile a dyspepsia-provoking effect of the non-ulcer drug would manifest
as an excess of individuals with the ulcer drug prescribed last. This
screening method is robust to confounders that are stable over time. R
esults Only non-steroidal antiinflammatory drugs (adjusted rate ratio
(RR) 1.8, 95% confidence interval (CI), 1.6-2.0), calcium blockers (RR
1.4, CI 1.2-1.7), corticosteroids (RR 1.1, CI 1.0-1.3), angiotensin c
onverting enzyme inhibitors (RR 1.4, CI 1.1-1.7) and methylxanthines (
RR 1.5, CI 1.1-2.2) showed a significant asymmetry suggesting a dyspep
sia-provoking effect. An analysis of effect modifiers suggested that t
he signals for corticosteroids and for angiotensin converting enzyme i
nhibitors were explained by concurrent use of nonsteroidal anti-inflam
matory drugs and by underlying congestive heart failure. The signal fo
r non-steroidal anti-inflammatory drugs may be explained by the known
reputation of non-steroidal antiinflammatory drugs for causing ulcers.
Conclusion There are hardly any important unknown drug effects that m
imic acid related dyspepsia. Drug-induced dyspepsia contributes little
to the overall use of ulcer drugs.