SCREENING FOR DRUG-RELATED DYSPEPSIA - AN ANALYSIS OF PRESCRIPTION SYMMETRY

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.