Nielsen GL, Sorensen HT, Mellemkjoer L, et al. Am J Med. 2001;111:541–545
Purpose of the Study.
The authors assessed the risk of hospitalization for upper gastrointestinal bleeding among patients using systemic corticosteroids, accounting for the use of other drugs that may increase the risk of bleeding.
Study Population and Methods.
The authors conducted a population-based cohort study in North Jutland County, Denmark. Data on the use of corticosteroids, nonsteroidal antiinflammatory drugs, aspirin, and anticoagulants during 1991–1995 were obtained from a countywide prescription database. All hospitalizations attributable to upper gastrointestinal bleeding were identified through the Hospital Discharge Registry. The observed numbers of patients with gastrointestinal bleeding in various exposure categories among corticosteroid users were compared with the expected number based on the North Jutland population who did not receive prescriptions for any of the drugs under study.
A total of 45 980 patients accrued 18 379 person-years of corticosteroid use. There were 109 hospital admissions for gastrointestinal bleeding among corticosteroid users, compared with 26 expected, yielding a relative risk of 4.2 (95% confidence interval [CI]: 3.4–5.0). Among corticosteroid users who did not use other drugs associated with gastrointestinal bleeding, the relative risk was 2.9 (95% CI: 2.2–3.7). The relative risk decreased further to 1.9 (95% CI: 1.4–2.5) when current corticosteroid usage was compared with former usage.
We observed an increased risk of hospitalization because of upper gastrointestinal bleeding among patients prescribed corticosteroids, especially among those who use other medications. Confounding from the underlying disease may also have contributed to the observed increase in risk.
It seems that I’m using oral corticosteroids less for asthma, but more for chronic rhinosinusitis and urticaria/angioedema. This study reminds us to consider the additive risks of gastrointestinal bleeding in corticosteroid treated patients who are also taking nonsteroidal antiinflammatory drugs and/or anticoagulants or who have other comorbid predisposing conditions.