Patients underreported their use of common but potentially dangerous over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), according to research presented at the Annual Scientific Meeting of the American College of Gastroenterology. “This is a serious issue given what we know about the significant risk of injury and bleeding in the GI tract in patients using NSAIDs,” said David Johnson, MD, FACG, one of the researchers.
Serious gastrointestinal (GI) complications such as bleeding, ulceration and perforation can occur with or without warning in people who take NSAIDS. With millions taking NSAIDs every day, it is estimated that more than 100,000 Americans are hospitalized each year and between 15,000 and 20,000 Americans die each year from ulcers and GI bleeding linked to NSAID use.
Of particular concern are patients with arthritis. More than 14 million such patients consume NSAIDs regularly. Up to 60 percent will have GI side effects related to these drugs and more than 10 percent will stop taking recommended medications because of troublesome GI symptoms.
Under-reported NSAID Use
Dr. Johnson and his colleagues at Eastern Virginia Medical School found that almost one in five patients at a private gastroenterology practice used NSAIDs but did not verbally report their use to nursing staff. For 22 percent of participants, they did not think the medications were important enough to list, and 30 percent cited the fact that the drugs were not prescribed by a physician. “This reflects a common misperception that these medications are insignificant or benign when actually their chronic use, particularly among the elderly and those with conditions such as arthritis, is linked to serious and potentially fatal GI injury and bleeding,” noted Dr. Johnson.
Arthritis Foundation Chief Science Officer, John A. Hardin, MD, warns that patients who take over-the-counter pain medications on a regular basis should talk with their physician about the potential for ulcers and other GI side effects.
Acid Suppression to Protect Stomach
Recent research suggests a role for acid suppression therapy with a proton pump inhibitor (PPI) for patients at risk of developing stomach ulcers due to long-term NSAID use. In another study presented at the American College of Gastroenterology, Neena S. Abraham, MD, looked at the burden of cost from hospitalization for GI bleeding related to NSAID use, and conducted a cost-benefit analysis of using PPIs to help protect against injury to the GI tract.
“Our analysis of a large patient population suggests that it is cost beneficial to administer a proton pump inhibitor with NSAIDs and points to significant savings in hospital costs relating to GI injury and bleeding in the Veterans’ Administration medical setting,” explained Dr. Abraham.
Dr. Abraham and her colleagues reviewed prescription and medical records for nearly half a million people using the VA medical system and Medicare. Dr. Abraham identified 3,200 events of GI bleeding, of which 36 percent were treated by the VA. A review of their prescription and hospitalization records revealed that half of those with GI bleeding events were hospitalized. Importantly, the one-third of patients with GI bleeding events prescribed a PPI were 60 percent less likely to be hospitalized. Their overall median total medical costs were significantly lower than patients who were not prescribed a PPI.
Although there are costs to treat patients taking NSAIDs with preventive PPIs, these findings suggest that reduced hospitalization costs offset higher pharmacy costs.
This summary was adapted from a press release issued by the American College of Gastroenterology.
Read more about NSAID risks and benefits here.