CLINICAL ASPECTS OF UPPER GASTROINTESTINAL-BLEEDING ASSOCIATED WITH THE USE OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Objective: The aim of this study was to compare the clinical features of major upper gastrointestinal bleeding among patients exposed to non steroidal antiinflammatory drugs (NSAID) and those not taking these dr ugs. Methods: Using data from a multicenter international case-control study designed to evaluate the role of drugs in the etiology of major upper gastrointestinal bleeding (UGIB), patients with a confirmed fir st episode of major UGIB were divided into two groups: those exposed t o NSAIDs during the week before the onset of bleeding, and those not e xposed. The groups were compared according to age and sex, clinical ap pearance and site of the bleeding, preceding symptoms, and requirement for transfusion and acute surgery. Results: The median age was signif icantly higher and the proportion of women was slightly higher among t he NSAID users. There was no significant difference between users and nonusers according to the clinical presentation, the site of the bleed ing, or the frequency of preceding symptoms. Forty percent in each gro up had no symptoms before the onset of bleeding. Slightly more NSAID u sers received blood transfusions, although the same median amount of b lood per transfusion was given in both groups. There was no difference in the frequency of surgical intervention. Conclusions: There are no important differences in the clinical presentation of major UGIB accor ding to whether or not an individual is an NSAID user. An important fi nding is the frequent absence of preceding symptoms in patients with m ajor UGIB, regardless of NSAID use. (C) 1998 by Am. Coll. of Gastroent erology.