Nonsteroidal Anti-Inflammatory Drugs Induce Asymptomatic Gastroduodenal Ulcers in the Japanese Population: A Case-Control Study on Its Prevalence and the Protective Effect of Anti-Ulcer Agents

Abstract

We report the first case-control study in Japan on the prevalence of non-steroidal anti-inflammatory drug (NSAID)-induced gastroduodenal ulcer and the prophylactic effect of co-administered anti-ulcer drugs in regular NSAID users. The NSAID users were 125 patients with rheumatoid arthritis (RA) and without gastrointestinal symptoms while regularly taking NSAIDs (>1 month). The NSAID non-users were125 age- and sex-matched healthy individuals seen between April 2001 and September 2003. Gastric ulcer prevalence was significantly higher among NSAID users than non-users and the odds ratio was 9.50 (95% CI: 2.21-40.8), while that of duodenal ulcers and reflux esophagitis was similar between users and non-users and the odds ratios were 1.11 (0.45-2.73) and 2.00 (0.68-5.85), respectively. The odds ratios for ulcers with concomitant treatment with a proton pump inhibitor or prostaglandin E1 analogue were 0.12 and 0.72 respectively, and were even lower than H₂ receptor antagonist and mucosal-protective drug. In conclusion, gastric ulcer prevalence was significantly higher in Japanese RA patients using NSAIDs than in healthy non-users. Concomitant proton pump inhibitor or prostaglandin therapy was effective in preventing NSAID-induced ulcers.