J Korean Soc Spine Surg.  2011 Dec;18(4):239-245. 10.4184/jkss.2011.18.4.239.

Gastrointestinal Risk Assessment in the Patients Taking Nonsteroidal Anti-inflammarory Drugs for Lumbar Spinal Disease

• Lee BH
• Shin BJ
• Kim DJ
• Lee JC
• Suk KS
• Park YS
• Kim KW
• Cho KJ
• Shin KY
• Koh MS
• Moon SH

• KMID: 1448002
• DOI: http://doi.org/10.4184/jkss.2011.18.4.239

Abstract

STUDY DESIGN: A cross-section observational study.
OBJECTIVES
To evaluate the current prescription patterns of non-steroidal anti-inflammatory drugs (NSAIDs) and gastrointestinal (GI) risk assessment in patients with lumbar spine disease. SUMMARY OF LITERATURE REVIEW: NSAIDs are commonly prescribed medications for lumbar spine disease patients. Since the rate of GI complication varies for each patient, identification of individual GI risks is a prerequisite to prevent such a complication. There are few reports about the GI risks in patients with lumbar spine disease who take NSAIDs.
MATERIALS AND METHODS
2264 patients with lumbar degenerative spondylopathy who were taking NSAIDs were enrolled from May 2010 to September 2010. The Standardized Calculator of Risk for Event (SCORE) was used to measure patients' GI risk factors. NSAID prescription patterns and GI protective agents were also investigated.
RESULTS
Being aged over 65 (1098 patients; 48.5%) and the presence of GI side-effects from NSAIDs (896 patients; 39.6%) were the most common risk factors. 31.9% and 5.8% percent of patients belonged to each of the high risk and the very high risk groups in GI risk factor analysis. The total prescription rate of gastroprotectants was 91.7% for all patients. However, the prescription rate of selective COX-2 inhibitors in the high risk group was low, and in 54.8% of patients who took COX-2 inhibitors there was GI discomfort.
CONCLUSIONS
The prescription pattern of GI protective agents was not correlated with GI symptoms. Therefore, physicians should consider NSAID prescription based on the GI risk factors of individual patients.

Keyword

Lumbar spine; NSAIDs; Gastrointestinal; Risk

MeSH Terms

Aged
Anti-Inflammatory Agents, Non-Steroidal
Cyclooxygenase 2 Inhibitors
Humans
Prescriptions
Protective Agents
Risk Assessment
Risk Factors
Spinal Diseases
Spine
Anti-Inflammatory Agents, Non-Steroidal
Cyclooxygenase 2 Inhibitors
Protective Agents

Figure

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  Fig. 1. Distribution of diagnoses among the enrolled patients is shown

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  Fig. 2. Percentage of patients with GI risk factors11) GI : gastrointestinal, NSAIDs : non-steroidal antiinflammatory drugs Hx : history

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  Fig. 3. Distribution of GI risk group according to SCORE system10) is shown. The ‘very high(risk 4)’ and ‘high(risk 3)’ groups were classified as the high GI risk group. Risk 4 (very high) : more than 20 points Risk 3 (high) : 16-20 points Risk 2 (moderate) : 11-15 points Risk 1 (low) : 10 or less points

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  Fig. 4. (A) Total Prescription rate of COX-2 inhibitors and other NSAIDs in high risk group are shown. The prescription rate of selective COX-2 inhibitor was 43.1% in total. (B) Prescription rate of COX-2 inhibitors and other NSAIDs in non-GI protective agent prescribed high risk patients group are shown. The prescription rate of selective COX-2 inhibitor was 71.8% in the non-GI protectant prescribed group. (C) Prescription rate of COX-2 inhibitors and other NSAIDs in GI protective agent prescribed high risk patients group are shown. The prescription rate of selective COX-2 inhibitor was 40.8% in the GI protectant prescribed group. : selective Cyclo-oxygenase type 2 inhibitor : Other Non-steroidal antiinflammatory drugs

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  Fig. 5. (A) Prescription Pattern of the gastroprotectives in the GI high risk group is shown. The mucoprotectants and gastroprokinetics were the most prescribed GI protective agent in order. (B) Prescription Pattern of the gastroprotectives in the GI symptomatic patients group is shown. In GI symptomatic group, the mucoprotectants and H2RA were the most prescribed. (C) Prescription Pattern of the gastroprotectives in the GI asymptomatic patients group is shown. In GI asymptomatic group, the mucoprotectants and gastroprokinetics were the most prescribed. H2RA: histamine type 2 receptor antagonist NSAIDs:non-steroidal antiinflammatory drugs PPI:proton pump inhibitor

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