Steroids and risk of upper gastrointestinal complications

Most antiinflammatory drugs have been associated with an increase in upper gastrointestinal complications. However, the literature on steroids is more limited than that on nonsteroidal antiinflammatory drugs (NSAIDs). To esti mate the risk of upper gastrointestinal complications associated with use o f steroids alone and in combination, a nested case-control analysis was con ducted on the General Practice Research Database from the United Kingdom. T he authors identified 2,105 cases of upper gastrointestinal complications a nd 11,500 controls between 1993 and 1998. The adjusted odds ratios associat ed with current use of oral steroids were 1.8 (95% confidence interval (CI) : 1.3, 2.4) for upper gastrointestinal complications overall and 2.4 (95% C I: 1.7, 3.4) for gastric and 1.2 (95% CI: 0.8, 1.9) for duodenal damage. St eroids were similarly associated with bleeding (odds ratio (OR) = 1.8; 95% CI: 1.3, 2.4) and perforations (OR = 1.6; 95% CI: 0.9, 3.1). Simultaneous u se of steroids with low-medium and high NSAID doses, respectively, produced odds ratios of 4.0 (95% CI: 1.3, 12.0) and 12.7 (95% CI: 8.2, 26.1), compa red with users of none. Whenever possible, antiinflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce t he risk of upper gastrointestinal complications.