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©2009 The WJG Press and Baishideng.
World J Gastroenterol. Dec 21, 2009; 15(47): 5953-5959
Published online Dec 21, 2009. doi: 10.3748/wjg.15.5953
Published online Dec 21, 2009. doi: 10.3748/wjg.15.5953
Table 1 A summary of the main questions (from a total of 22) assessing physicians’ knowledge of current evidence in the field of NSAID use and adverse effects
NSAID use is associated with adverse effects. Which of the following do you believe is not associated with NSAID use? |
What is the expected annual incidence of upper GI complications in patients taking NSAIDs, as reported in the most recent large outcome studies? |
The occurrence of dyspepsia in patients who take NSAIDs has been reported to be less than 25% (true or false) |
NSAIDs may induce GI complications in the lower GI tract (true or false) |
Which of the following factors do you believe is/are risk factors for GI complications in patients who take NSAIDs? (list) |
Which of the following NSAIDs do you believe is more toxic to the GI tract? (list) |
Concerning COX-2 selective inhibitors, for each of the following, indicate whether the statement is true or false: |
They are not as effective as traditional NSAIDs in the treatment of OA or RA |
The use of these compounds is associated with a 50% reduction in the risk of GI complications compared to NSAIDs |
The concomitant use of low-dose aspirin reduces or eliminates the GI benefit of these compounds when compared to NSAIDs |
The use of these compounds has been associated with an increased risk of CV events |
In high-risk patients, the combination of NSAIDs plus a PPI is safer than a coxib alone |
Concerning gastroprotective agents, indicate for each of the following statements whether they are true or false: |
H2-RAs are effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications |
PPIs are effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications |
Misoprostol is effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications |
Which of the following agents has been proved to be effective in the treatment or prevention of NSAID-induced dyspepsia? (list) |
Table 2 Responses to the question, “Which of the following factors do you believe is/are risk factors for GI complications in patients who take NSAIDs”n (%)
Rheumatologists | Orthopedic surgeons | Others | Total | |
History of peptic ulcer | 115 (99.1) | 275 (98.2) | 21 (100.0) | 411 (98.6) |
History of complicated peptic ulcer | 116 (100.0) | 275 (98.2) | 21 (100.0) | 412 (98.8) |
Age > 65 yr | 114 (98.3) | 229 (81.8) | 18 (90.4) | 361 (86.6) |
Concomitant use of low-dose aspirin for CV prevention | 114 (98.3) | 228 (81.4) | 19 (90.4) | 361 (86.6) |
Concomitant use of anticoagulants | 112 (96.5) | 247 (88.2) | 20 (95.3) | 379 (90.9) |
Helicobacter pylori infection | 103 (88.8) | 257 (91.8) | 19 (90.4) | 379 (90.9) |
Smoking | 87 (75.00) | 223 (79.6) | 13 (61.7) | 323 (77.5) |
Dyspepsia history | 73 (62.9) | 250 (89.3) | 19 (90.4) | 342 (82.0) |
Alcohol | 105 (90.5) | 257 (91.8) | 20 (95.3) | 382 (91.6) |
High dose of NSAIDs | 113 (97.4) | 275 (98.2) | 21 (100.0) | 409 (98.1) |
Table 3 Characteristics of patients included in the educational program of the study1n (%)
Variable | Phase I (n = 1732) | Phase II (n = 1722) |
Age (mean ± SD) | 61.06 ± 13.37 | 60.81 ± 13.89 |
Female | 1038 (60.4) | 980 (57.6) |
History of ulcer | 238 (13.7) | 307 (17.8) |
History of ulcer bleeding | 61 (3.5) | 69 (4.0) |
ASA use | 167 (9.6) | 168 (9.8) |
CV history | 203 (11.7) | 205 (11.9) |
Increased blood pressure | 845 (48.8) | 810 (47.0) |
Anticoagulant use | 126 (7.3) | 120 (7.0) |
Corticosteroid use | 162 (9.3) | 190 (11.0) |
History of dyspepsia | 782 (45.1) | 766 (44.5) |
Table 4 Prescription of NSAIDs to patients in each of the two study phases of the educational program n (%)
Drug therapy | Phase I | Phase II | ||
Before visit | After visit | Before visit | After visit | |
No NSAID therapy | 718 (41.45) | 162 (9.35) | 653 (37.92) | 190 (11.03) |
NSAID therapy | 1014 (58.55) | 1570 (90.65) | 1069 (62.08) | 1532 (88.97) |
Aceclofenac | 146 (8.43) | 248 (14.32)b | 148 (8.59) | 202 (11.73)b |
Celecoxib | 45 (2.60) | 100 (5.77)b | 35 (2.03) | 116 (6.74)b |
Diclofenac | 229 (13.22) | 271 (15.65) | 238 (13.82) | 270 (15.68) |
Etoricoxib | 16 (0.92) | 46 (2.66)b | 18 (1.05) | 79 (4.58)b |
Ibuprofen | 281 (16.22) | 432 (24.94)b | 297 (17.25) | 406 (23.58)b |
Indomethacin | 63 (3.64) | 62 (3.58) | 73 (4.24) | 75 (4.36) |
Ketorolac | 15 (0.87) | 25 (1.44) | 28 (1.63) | 31 (1.80) |
Meloxicam | 71 (4.10) | 234 (13.51)b | 101 (5.87) | 215 (12.49)b |
Piroxicam | 74 (4.27) | 75 (4.33) | 64 (3.72) | 64 (3.72) |
Other NSAIDs includes aproxen) | 19 (1.10) | 22 (1.27) | 16 (0.93) | 28 (1.63) |
Analgesics | ||||
Paracetamol | 137 (7.91) | 120 (6.93) | 136 (7.90) | 122 (7.08) |
Metamizol | 35 (2.02) | 28 (1.62) | 53 (3.08) | 26 (1.51) |
Total | 1732 (100) | 1722 (100) |
Table 5 Risk factors (RFs) of patients reported by doctors in the educational program according to either a non-restrictive or a restrictive definition1n (%)
Table 6 Proportion of patients on NSAID therapy that received concomitant therapy with a PPI or misoprostol after the medical visit, according to the number of RFs n (%)
Number of RFs | Non-restrictive | Restrictive | ||
Phase I | Phase II | Phase I | Phase II | |
0 | 268/347 (77.2) | 283/352 (80.4) | 782/961 (81.4) | 728/891 (81.7) |
1 | 536/660 (81.2) | 499/598 (83.4) | 471/558 (84.4) | 504/573 (87.9) |
2 | 453/517 (87.6) | 456/536 (85.1) | 151/176 (85.8) | 168/213 (78.9) |
> 2 | 175/208 (84.1) | 201/236 (85.2) | 28/37 (75.7) | 39/45 (86.7) |
- Citation: Lanas A, Esplugues JV, Zapardiel J, Sobreviela E. Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications. World J Gastroenterol 2009; 15(47): 5953-5959
- URL: https://www.wjgnet.com/1007-9327/full/v15/i47/5953.htm
- DOI: https://dx.doi.org/10.3748/wjg.15.5953