Nonsteroidal anti-inflammatory drug associated lesions and mortality among African American and Hispanic patients with lower gastrointestinal bleeding

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are toxic to the entire gastrointestinal (GI) tract. Although there is a plethora of data about upper GI toxicity of NSAIDs, the data are scant about lower GI toxicity, particularly in African Americans and Hispanics, our main patient population. We studied the association between NSAIDs use and lower GI lesions in patients with lower GI bleeding (LGIB). Records of 988 patients, 19 to 103 years old, admitted with a diagnosis of LGIB over 12 years (from 1991 to 2002), were reviewed retrospectively. We excluded 230 patients (44 white, 45 Asian, 98 with upper GI source of LGIB, and 43 with incomplete data). The information abstracted included admission diagnoses, NSAIDs and/or aspirin (NSAIDs/AS) use, colonoscopic findings, and outcome measures (duration of hospitalization; surgery; mortality). Among the 758 patients (411 African American and 347 Hispanics), 47% were taking NSAIDs/AS regularly and 53% were not taking NSAIDs/AS. Colonoscopic findings revealed that the common lesions were colonic diverticulosis (36%), angiodysplasia (29%), colonic polyps (25%), and hemorrhoids (24%). Colonic diverticulosis, colonic ulcers, and inflammatory bowel diseases were significantly higher among NSAIDs/AS users than among nonusers ( P < 0.05). On average, NSAIDs/AS users had longer hospital stays (5 days) than nonusers (3 days). Of the 758 patients, 13% had surgery because of severe bleeding. Surgical intervention was more likely among NSAIDs/AS users (16%) than among nonusers (11%) (odds ratio OR = 1.6, 95% confidence interval CI = 1.0–2.4, P = 0.04). Overall, 160 deaths occurred (21%). Mortality was significantly higher among NSAIDs/AS users (29%) than among nonusers (14%) (OR = 2.6, 95% CI = 1.8–3.7, P = 0.0001). Morbidity, mortality, and need for surgery were higher among NSAIDs/AS users than nonusers. Future prospective studies in this population may help in better management and possible risk reduction.