Low mortality and morbidity of upper gastrointestinal bleeding in Crete. The role of individual non steroidal anti-inflammatory drugs (NSAIDs)

Abstract

SUMMARY
Aim: To estimate the mortality and morbidity of upper gastrointestinal
bleeding and to assess the role and relative
safety of the common anti-inflammatory drugs (NSAIDs).
Materials/Methods: The clinical outcome of 444 patients with
upper GI bleeding, admitted to the University Hospital of
Heraklion, in relation to the consumption of various
NSAIDs was studied prospectively over a 4 year period
(1992-1995).
Results: The median age of the patients was 62 and the male
to female ratio 1.4: 1. In 64.2% of the cases a gastroduodenal
ulcer was found. There was a history of NSAID use in
60.6% of patients and NSAID administration was associated
significantly with antral erosions (81.7%). Operation and
mortality rate were 3.6% and 2.7% respectively. Taking into
account the local drug circulation, salicylates, piroxicam
and ibuprofen were estimated to have the highest relative
risk of bleeding. Drugs used mostly in parenteral or rectal
forms were considered safer. No significant association was
found between NSAID consumption and age, sex, operation
and mortality rate.
Conclusions: The operation and mortality rate in patients
with upper gastrointestinal bleeding in Crete is remarkably
low. NSAID use is strongly associated with upper gastrointestinal
hemorrhage and certain brands of NSAIDs
have a higher relative risk of bleeding. Parenteral or rectal
administration of low-danger drugs is recommended.
Key words: upper gastrointestinal bleeding, non-steroidal
anti-inflammatory drugs (NSAIDs), peptic ulcer