Audit on Prescription and Other Related Matters of Adult Sri Lankans, on NSAIDs Including Low Dose Aspirin, Referred to Medical Unit of a Tertiary Referral Centre

Abstract

Purpose: Many patients are prescribed NSAIDs and low dose aspirin worldwide for various reasons, which are potential gastrointestinal hazards. We have carried out a clinical audit on NSAID prescription patterns and other related matters in adult Sri Lankans who obtained the services of medical gastroenterology unit of a tertiary care hospital. Methods: The case notes of all patients who sought the services of the principal authors unit at SJGH, Kotte, Sri Lanka from 01st July 2009 to 31st May 2010 for NSAIDs related matters were retrospectively analysed. Results: The total population comprised 97 with a sex ratio of male:female 32:60 (2:3). Age range was 20-80 years. 41-50 years and 61-70 years age groups had 25% each. Gastroscopies were done for dyspepsia, upper GI bleeding and unexplained anaemia in 75%, 13% and 12%, respectively. Low dose aspirin was prescribed in 35%, 10% and 2% for secondary prevention of ischaemic heart disease, primary prevention of ischeamic heart disease and cerebrovascular accidents respectively. Osteoarthitis was the major reason for NSAIDs prescription (10%). 50% had been on treatment up to 1 year, while 20% of low dose aspirin group had been treated over 5 years. 47% had been on low dose aspirin. 25% had been on multiple NSAIDs regimes. Low dose aspirin and NSAIDs were combined in 5%. Clopidogrel and steroids were co prescribed in 25% and 5% respectively. 53% had Proton pump inhibiter (PPI) prophylaxis of which 48% were dyspeptics. 55% had reflux symptoms, 38% non reflux symptoms, while 4% were asymptomatic. 88% were not offered alternative pain relief methods. 12% had a previous history of upper GI bleed. 17% were smokers while 20% consumed alcohol. 78% were unaware of NSAIDs hazards. Endoscopy revealed gastritis, gastric erosions gastric ulcers, oesophagitis, duodenal ulcers and normal appearance in 60%, 14% 7%, 5%, 3% and 2%, respectively. Majority had overlapping endoscopic pathologies. Helicobacter pylori (H. pylori) were identified in 19% and 11% NSAIDs and low dose aspirin users, respectively. Conclusion: Guidelines are needed for more rational use of NSAIDs to minimise GI complications in this part of the world. Presence of H. pylori seems to be comparatively low in low dose aspirin users, which needs further evaluation.