Corticosteroid Use and Peptic Ulcer Disease: Role of Nonsteroidal Anti-inflammatory Drugs
Publication: Annals of Internal Medicine
Volume 114, Number 9
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Abstract
Objective: To estimate the relative risk for peptic ulcer disease that is associated with the use of oral corticosteroids.
Design: A nested case-control study.
Setting: Tennessee Medicaid program.
Participants: The case patients (n = 1415) were hospitalized between 1984 and 1986 for gastric or duodenal ulcer or for upper gastrointestinal hemorrhage of unknown cause. The controls (n = 7063) were randomly selected from Medicaid enrollees not meeting the study criteria for inclusion as case patients.
Measurements and Main Results: The estimated relative risk for the development of peptic ulcer disease among current users of oral corticosteroids was 2.0 (95% CI, 1.3 to 3.0). However, the risk was increased only in those who concurrently received nonsteroidal anti-inflammatory drugs (NSAIDs); these persons had an estimated relative risk associated with current corticosteroid use of 4.4 (CI, 2.0 to 9.7). In contrast, the estimated relative risk for those corticosteroid users not receiving NSAIDs was 1.1 (CI, 0.5 to 2.1). Persons concurrently receiving corticosteroids and NSAIDs had a risk for peptic ulcer disease that was 15 times greater than that of nonusers of either drug.
Conclusion: Discrepant findings among earlier studies regarding steroids and the risk for peptic ulcer disease could in part be due to differences in the use of NSAIDs among study participants. The high risk for peptic ulcer disease associated with combined use of NSAIDs and corticosteroids indicates the need to prescribe this drug combination cautiously.
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 114 • Number 9 • 1 May 1991
Pages: 735 - 740
History
Published in issue: 1 May 1991
Published online: 1 December 2008
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© 1991 American College of Physicians.
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Corticosteroid Use and Peptic Ulcer Disease: Role of Nonsteroidal Anti-inflammatory Drugs. Ann Intern Med.1991;114:735-740. doi:10.7326/0003-4819-114-9-735
Corticosteroid Use and Peptic Ulcer Disease: Role of Nonsteroidal Anti-inflammatory Drugs. Ann Intern Med.1991;114:735-740. doi:10.7326/0003-4819-114-9-735
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