ASSOCIATION OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS WITH OUTCOME IN UPPER AND LOWER GASTROINTESTINAL-BLEEDING

Although nonsteroidal antiinflammatory drug (NSAID) use is strongly as sociated with both upper gastrointestinal bleeding (UGIB) and lower ga strointestinal bleeding (LGIB), few data exist regarding the outcome o f the bleeding episode for those consuming these drugs. Consecutive pa tients with UGIB or LGIB evaluated during the period August 1, 1990 th rough September 30, 1994 at a large inner city hospital were prospecti vely identified, Both prescription and over-the-counter NSAID use was specifically evaluated, Endoscopy was performed in most patients for d iagnosis. Outcome measures included transfusion requirement, hospital stay, need for endoscopic therapy or surgery, and death. Over the 50-m onth study period, 785 patients admitted with UGIB and 161 with LGIB w ere studied. NSAID use was documented in 59% of patients with UGIB and 51% with LGIB, In UGIB, NSAID users were more likely to be female and older. NSAID users had a significantly shorter median hospital stay ( 4 vs 5 days), less rebleeding (11% vs 18%; P = 0.004) and in-hospital mortality (5% vs 13%; P = 0.001) as compared to nonusers, These differ ences remained significant when controlling for age, race, and gender. Similar trends in outcome were seen when evaluating ulcer- and non-ul cer-related bleeding, NSAID users with LGIB were more likely to be fem ale, although rebleeding (19% vs 21%), hospital stay, and in-hospital mortality (5% vs 2%) were not significantly different between users an d nonusers. UGIB in NSAID users appears to have a better prognosis as compared to nonusers. In contrast, NSAID use does not appear to be ass ociated with outcome in patients with LGIB.