Are Patients Aware of Upper Gastrointestinal (GI) Side Effects of Nonsteroidal Anti-inflammatory Drugs (NSAIDs)? An Inner City Community Hospital Experience

Abstract

Purpose: NSAID associated GI side effects are a significant cause of morbidity and mortality. Although much is known about NSAIDs and their GI side effects, little is known about patient awareness of NSAID related upper GI side effects in the United States. The aim of our study was to evaluate patient awareness about NSAID induced upper GI side effects. Methods: A retrospective analysis utilizing a standard questionnaire completed during physician encounter at Interfaith Medical Center, Brooklyn NY from March to May 2009. All patients 18 years of age or older currently taking NSAID or having used NSAID in the last 2 years were included in the study. Those who never used NSAID and critical care patients were excluded. The questionnaire included demographics, co-morbidities, indication and duration of NSAID use and awareness of upper GI side effects. Complications of NSAID such as heartburn, abdominal pain, ulcer, bleeding and perforation were evaluated. There were 130 females and 180 males included in the study. The data was analyzed using regression analysis, t-test, correlation and Chi-square test as indicated. Results: The ages ranged from 18-93 years with mean age of 52 years. African-Americans comprised 88.7% of the study population. Only 15.8% patient had achieved education beyond high school. Motrin was the most commonly used NSAID (41.6%) and 37.7% patients had used two or more types of NSAIDs at different times. 68% of patients were not aware of any upper GI side effects while 32% were aware of some side effects. Of those who were aware of some side effects, only 44% patients knew NSAIDs could cause peptic ulcers and upper GI bleeding. About 50% of patients who were prescribed NSAID claimed that they were not counseled of potential GI side effects. Patients who had used 2 or more types of NSAID were more aware of side effects compared to those taking less than 2 types (p: 0.016). Among those patients who had used multiple NSAIDs, only 30% had been made aware of upper GI side effects (p: 0.009). 37% of patients who claimed they read side effects profile of NSAID were aware of some side effects compared to 14% of those who never read side effects profile (p: 0.04). Only 5 out of 26 patients with PUD were aware of side effects (p: 0.02). There was no statistically significant difference in awareness in terms of education, duration, indications and between patients who were prescribed vs. those who took OTC. Conclusion: Despite the associated significant mortality and morbidity and high cost of treatment, most patients remain unaware of upper GI side effects of NSAID. We can hope that increased patient knowledge of side effects may reduce the incidence and prevalence of GI complications due to these medications.Table