Italian survey on non-steroidal anti-inflammatory drugs and gastrointestinal bleeding in children

Table 1 Baseline characteristics of 51 patients with gastrointestinal bleeding following non-steroidal anti-inflammatory drug consumption n (%)

Characteristics	Patients
Median age (range)	7.6 yr (5 mo-15.3 yr)
Gender
Male	34 (66.7)
Female	17 (33.3)
Indications for drug use
Pain	29 (56.9)
Fever	21 (41.2)
Inflammation	1 (2)
Comorbidities (n = 12)
Cardiovascular disease	1 (2)
Celiac disease	1 (2)
Cystic fibrosis	1 (2)
Diaphragmatic hernia	1 (2)
GERD	1 (2)
H. pylori infection	3 (5.9)
IBD	1 (2)
Neurological diseases/cognitive impairment	2 (3.9)
Pulmonary atelectasis	1 (2)
Other medications (n = 19)
Corticosteroids	7 (13.7)
Antibiotics	10 (19.6)
Acetaminophen	1 (2)
Baclofen	1 (2)

H. pylori: Helicobacter pylori; GERD: Gastroesophageal reflux disease; IBD: Inflammatory bowel disease; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Reports on non-steroidal anti-inflammatory drugs n (%)

NSAIDs	Patients	Age (mo)	Male gender	Dose (mg/kg)	No. of administrations	Duration (d)
Ibuprofen	35 (68.6)	66 (5-183)	20 (57.1)	10 (8-50)	7 (1-18)	4 (1-263)
Ketoprofen	5 (9.8)	125 (27-180)	4 (80)	2 (1-3)	4 (2-15)	5 (1-18)
Acetylsalicic ac.	4 (7.8)	143.5 (113-170)	3 (75)	60 (5-200)	2.5 (1-22)	14 (2-25)
Flurbiprofen	3 (5.9)	100 (73-116)	3 (100)	20 (3-25)	6 (4-9)	4 (3-4)
Ketoralac	1 (2)	142	1 (100)	3	1	1
Naproxen	1 (2)	76	1 (100)	25	5	2
Niflumic ac.	1 (2)	139	1 (100)	25	10	5
Nimesulide	1 (2)	166	1 (100)	2	2	6

Continuous variables are expressed as median and range. ac: Acid; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 3 Appropriateness of use and medical prescription of non-steroidal anti-inflammatory drugs n (%)

NSAIDs (n)	Inappropriate use1			Medical prescription
	Weight-dose	No. of administrations/d	Age
Ibuprofen (35)	4 (11.4)	10 (28.5)	0	26 (74.3)
Ketoprofen (5)	1 (20)	2 (40)	0	3 (60)
Acetylsalicic ac. (4)	0	0	4 (100)	1 (25)
Flurbiprofen (3)	2 (66.7)	2 (66.7)	0	2 (66.7)
Ketoralac (1)	0	1 (100)	0	1 (100)
Naproxen (1)	1 (100)	0	0	1 (100)
Niflumic ac. (1)	0	0	0	1 (100)
Nimesulide (1)	0	0	0	0

¹Number of patients inappropriately using NSAIDs in terms of weight-dose, number of administrations per day, and age. ac: Acid; NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 4 Detailed endoscopic findings in 51 patients presenting with gastrointestinal bleeding after non-steroidal anti-inflammatory drug use n (%)

Variables	≤3 yr(n = 11)	> 3 ≤7 yr(n = 14)	> 7 ≤16 yr(n = 26)	P value
Upper GI lesions				0.04
Proximal (esophagus and stomach)	10 (100)	12 (85.7)	15 (62.5)
Distal (duodenum)	0	2 (14.3)	9 (37.5)
Location				0.06
Esophagus	2 (18.1)	2 (14.3)	4 (15.4)
Stomach	8 (72.7)	10 (71.4)	11 (42.3)
Duodenum	0	2 (14.3)	9 (34.6)
Colon	1 (9)	0	1 (3.8)
Esophagus				0.90
Upper	0	0	0
Middle	0	0	0
Lower	2 (18.1)	2 (14.3)	4 (15.3)
Los Angeles classification				0.50
Grade A	2 (100)	2 (100)	3 (75)
Grade B	0	0	1 (25)
Grade C	0	0	0
Grade D	0	0	0
Stomach				0.09
Antrum	0	0	4 (36.4)
Body	4 (50)	4 (40)	3 (27.3)
Fundus	4 (50)	6 (60)	4 (36.4)
Type of lesions				0.40
Erythema	5 (62.5)	8 (80)	4 (36.4)
Edema	0	1 (10)	1 (9.1)
Erosions	2 (25)	1 (10)	3 (27.3)
Ulcerations	1 (12.5)	0	3 (27.3)
Duodenum				1.00
Bulb	0	2 (100)	8 (88.9)
Duodenum	0	0	1 (11.1)
Type of lesions				0.02
Nodularity	0	1 (50)	1 (11.1)
Erythema	0	1 (50)	0
Erosions	0	0	0
Ulcerations	0	0	8 (88.8)
Forrest Classification for ulcerations				0.30
Grade 1a	0	0	2 (18.2)
Grade 1b	0	0	1 (9.1)
Grade 2a	1 (100)	0	2 (18.2)
Grade 2b	0	0	0
Grade 2c	0	0	2 (15.4)
Grade 3	0	0	6 (54.5)
Colon
Transverse	1 (9)	0	0
Sigmoid	0	0	1 (3.8)
Type of lesions
Erythema	1 (100)	0	0
Edema	0	0	1 (100)

GI: Gastrointestinal; NSAIDs: Non-steroidal anti-inflammatory drugs.