Nonsteroidal Anti-inflammatory Drugs Users Research Articles

Attitude and Behavior towards Self-medication using Non-steroidal Anti-inflammatory Drugs and Paracetamol among Housewives in Hegarmanah Village, Jatinangor

Background : The use of drugs by self-medication is widely practiced worldwide. One of the most common drugs used without prescription is analgesic and this is predominantly used among housewives since they are sometimes suffering from minor ailments due to house chores burden. The study aimed to explore the attitude and behavior of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and paracetamol usage among housewives in Jatinangor, West Java-Indonesia. Methods : A cross-sectional study was performed from August–November 2013. After informed consent, housewives living in Hegarmanah village, Jatinangor were included by filling in a validated questionnaire to assess the level of attitude and behavior of NSAIDs and paracetamol usage. The data were presented in percentages. The score was given and categorized as good, moderate and poor for both attitude and behavior. Results : Of a total 110 housewives participated in this study, the attitude of housewife towards the drug use was good (59.1%), moderate (33.6%) and poor (7.3%), whereas the behavior was good (46.4%), moderate (52.7%) and poor (0.9%). Conclusions : The majority of the respondents have moderate to good attitude as well as behavior toward the usage of NSAIDs and paracetamol as self-medication. Public health education and awareness are important to ensure safe and useful self-medication.

Review on Effects of NSAID`S on Different Systems

Non steroidal anti-inflammatory drugs (NSAIDs) are amongst the most commonly prescribed medication. Some are available over the counter and likely to be abused. The gastrointestinal (GI), renal and cardiovascular (CV) side effects limit NSAIDs use. These side effects occurred at a rate as low as 1%–5% for NSAID users. The gastrointestinal (GI), renal and cardiovascular (CV) side effects limit NSAIDs use. Some studies have shown that an extra 2to8 per 1000 people per year may have a major vascular event from using an NSAID. Several studies demonstrated that conventional NSAIDs were associated with a higher risk of AKI and GN and decreased kidney hemodynamic functions, including sodium excretion. NSAIDs have a range of adverse effects mainly affecting the GI, renal and CV systems.

Increased risk of strokes in patients with chronic low back pain (CLBP): A nationwide population-based cohort study

ObjectivesThere have not been any longitudinal studies reported that chronic low back pain (CLBP) patients are at risk for stroke. Thus, in this study, we explored the association between CLBP and strokes. Patients and methodsData (2000∼2010) from the Taiwan National Health Insurance database were analyzed. We matched 10,308 CLBP patients with 20,616 propensity score-matched non-low back pain (NLBP) patients according to age, gender, index year and comorbidities. Covariates of age, gender, comorbidities, and usage of non-steroidal anti-inflammatory drugs (NSAIDs) were adjusted and analyzed. ResultsThe mean follow-up duration was 8 years. CLBP patients had higher risks of all stroke, hemorrhagic stroke, and ischemic stroke. The adjusted hazard ratios (aHRs) were 2.35 (95 % confidence interval (CI): 2.14–2.57, p < 0.001), 1.55 (95 % CI: 1.16–2.06, p = 0.003), and 2.41 (95 % CI: 2.18–2.66, p < 0.001), respectively. After adjusting and analyzing the NSAIDs used for the varied duration in the CLBP patients, we did not observe any impacts of such NSAIDs used on the association of CLBP with strokes. The association between CLBP and ischemic stroke was most prominent in the patients less than 50 years old with aHR: 3.56 (CI: 2.74∼4.61, p < 0.001). ConclusionCLBP was associated with increased risk of strokes, especially ischemic stroke, and the association was most prominent in patients less than 50 years old. Further large prospective studies on detailed lifestyle-related factors and qualitative pain assessment are needed to clarify the causal relationship between CLBP and stroke.

Concomitant Autoimmune Diseases in Patients With Sarcoidosis in Turkey

This study aims to determine the frequency and characteristics of autoimmune diseases associated with sarcoidosis patients. The study included 131 sarcoidosis patients (36 males, 95 females; mean age 46.1 years; range, 20 to 82 years). Demographic, clinical, laboratory and radiological data of patients were evaluated retrospectively. The characteristics of autoimmune diseases associated with sarcoidosis (sarcoidosis-overlap group) patients and isolated sarcoidosis (isolated sarcoidosis group) were analyzed and compared. Concomitant autoimmune diseases were detected in 15 (11.5%) (5 males, 10 females; mean age 50.8 years; range, 26 to 58 years) of the 131 patients with sarcoidosis and their mean disease duration was three months (range, 1 to 30 months). When compared with isolated sarcoidosis patients, more hand finger joint involvement, rheumatoid factor (RF) positivity, higher erythrocyte sedimentation rate (ESR) and less nonsteroidal anti-inflammatory drugs (NSAIDs) usage were found in the sarcoidosis-overlap group (p=0.035, p=0.049, p=0.015, p=0.018, respectively). There were no statistically significant differences between the two groups when evaluated for demographic, clinical parameters and disease-modifying antirheumatic drugs usage. Concomitant autoimmune diseases in patients with sarcoidosis may be rarely seen. These patients are characterized with more hand finger joint involvement, RF positivity, higher ESR and less NSAIDs usage. Multicenter, prospective studies involving large numbers of patients are needed to understand whether the association of sarcoidosis-autoimmune diseases is based only on coincidence or on a common etiopathogenesis.

The Pattern of Eosinophil Count among Nigerians with Frequent Use of the Commonly Available Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) use is very common. NSAIDs use could be associated with elevated eosinophil count which could be a class effect or patient-related. Inflammation could be the link between NSAIDs use and eosinophilia. Aims: To compare the pattern of eosinophil count in the peripheral blood of frequent users of NSAIDs and healthy controls. Methodology: Two hundred (one hundred frequent users of NSAIDs and 100 healthy controls) participants who had no known risk factor for kidney disease and had given informed consent were recruited. Blood was taken to determine the white cell count and differentials, serum electrolyte and creatinine, and random blood sugar. Results: The mean age of NSAIDs users was not significantly different from controls, P = 0.3. The mean eosinophil count was higher in males than females. The incidence of eosinophilia in NSAIDs users was 4%. The mean Eosinophil count of NSAIDs users was insignificantly higher than controls, 164.3 ± 51 6 vs 135. 6 ± 53.4, P = 0.4. The mean platelet count of NSAIDs users was significantly higher compared to controls, P = 0.04. The mean hematocrit of NSAIDs users was significantly lower than the controls, P = 0.02. Propionic acid derivatives were associated with the highest eosinophil count. Eosinophil count was positively related to age and serum creatinine and inversely related to blood glucose, hematocrit and glomerular filtration rate. Conclusion: The incidence of eosinophilia was 4%. The eosinophil count was higher in frequent NSAIDs users than occasional and non-users, in males than females and with use propionic acid derivatives compared to other NSAIDs. The Eosinophil count was positively related to age and platelet count. Being commoner in inflammatory states, the tissue destruction associated with elevated EC can be avoided by the prevention and prompt treatment of inflammatory conditions.

Kidney Function in Frequent Users of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are used for managing painful conditions. They are available as cheap, over-the-counter drugs, and commonly abused. NSAIDs inhibit prostaglandins (PGs) actions on the kidneys and can cause kidney disease and hypertension, especially when used in excess doses, for prolonged period or in stressed states. Methods: The descriptive study was carried at the Orthopaedic and Family Medicine units of the Federal Medical Centre, Abeokuta. Two hundred respondents participated in the study. One hundred frequent users of NSAIDs (with daily use for ≥ 4 weeks) and age and sex-matched controls with no known risk for kidney disease and had consented were consecutively recruited. Data were entered from history, examination and investigations (urinalysis, serum electrolyte, kidney scan and biopsy). Cases with estimated glomerular filtration rate (eGFR) < 60 mls/min/1.73 m2) and dip strip proteinuria ≥ 1+ had kidney biopsy. Statistical analysis was with SPSS 21 software. Student t-test and Chi-square tests were used to compare means and proportions respectively. Pearson’s correlation test was used to determine the strength of association between independent risk factors and kidney dysfunction (KD). Results: Two hundred respondents participated in the study. Fifty one (51) females and Forty nine (49) males were recruited as cases and controls respectively. Thirteen (13) females had KD compared to 9 males, (P = 0.02). The mean age of cases with KD (63.04 yrs ± 4.21) was statistically higher than those without KD (P = 0.01). Majority of the cases were in the working population (30 - 59 yrs). Twenty two (22) frequent NSAIDs users had kidney dysfunction (KD) while six (6%) controls had KD. The proportion of subjects that used herbal medicines was higher in cases with KD than in cases without KD as well as in the controls respectively (P = 0.01). The mean kidney length and cortical thickness were significantly lower in cases with KD than in cases without KD, (P = 0.03) and (P = 0.017) respectively. The independent predictors of KD were increasing age, use of herbal remedies and duration of drug use. Conclusion: The prevalence of KD among frequent NSAIDs users was 22%, higher than controls. Risk factors identified include increasing age, use of herbal medicines, increasing body mass index (BMI), systolic blood pressure (SBP), anaemia, reduced cortical thickness and kidney volume. NSAIDs use in excess doses, prolonged period or in stressed state increases the risk for kidney dysfunction, caution is therefore needed to avoid taking these drugs in these conditions.

Factors associated with the presence of abnormal levels of fecal calprotectin in patients with negative panenteric studies

fecal calprotectin is a selection tool prior to endoscopic studies in patients with gastrointestinal symptoms. However, some symptomatic patients with altered fecal calprotectin will not have any endoscopic lesions. The aim of the study was to determine the factors associated with the presence of altered fecal calprotectin in patients with negative endoscopic studies of the colon and small bowel. this was an observational, prospective study of patients with digestive symptoms. The association of different clinical factors with elevated fecal calprotectin in the absence of endoscopic lesions of the colon and small bowel were analyzed. 143 patients were included in the study, 98 were female (68.5 %) and the mean age was 40.06 ± 16.42 (15-82) years. Smoking and non-steroidal anti-inflammatory drug intake were associated with altered fecal calprotectin in patients with a negative endoscopy of the colon and small bowel (p = 0.029 and p = 0.006). The mean values of fecal calprotectin were significantly higher in smokers, users of non-steroidal anti-inflammatory drugs and patients with small intestine bacterial overgrowth. Smoking (OR: 3.505; p = 0.028), non-steroidal anti-inflammatory drugs intake (OR: 3.473; p = 0.021) and small intestine bacterial overgrowth (OR: 3.172; p = 0.013) were independent risk factors for altered fecal calprotectin in the absence of endoscopic lesions. No association was found for any of the other variables. smoking and the use of non-steroidal anti-inflammatory drugs are strongly associated with elevated levels of fecal calprotectin in symptomatic patients with a negative colonoscopy and capsule endoscopy of the small bowel. Small intestine bacterial overgrowth is also associated.

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain

Background/aim The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular nerves for chronic refractory knee pain due to osteoarthritis (OA).Materials and methodsForty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and 6 months after the procedure.ResultsThe mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P < 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that 66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after the procedure. Conclusion In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.

Prevalence of non-steroidal anti-inflammatory drugs usage and assessment of knowledge related to its complications among Saudi population; a cross-sectional study

Prevalence of non-steroidal anti-inflammatory drugs usage and assessment of knowledge related to its complications among Saudi population; a cross-sectional study

Cost-effective Analysis of Proton Pump Inhibitors in Long-term Management of Gastroesophageal Reflux Disease: A Narrative Review.

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that results from regurgitation of acid from the stomach into the esophagus. Treatment available for GERD includes lifestyle changes, antacids, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and anti-reflux surgery. Aim: The aim of this review is to assess the cost-effectiveness of the use of PPIs in the long-term management of patients with GERD. Method: We searched in PubMed to identify related original articles with close consideration based on inclusion and exclusion criteria to choose the best studies for this narrative review. The first section compares the cost-effectiveness of PPIs with H2RAs in long-term heartburn management. The other sections shall only discuss the cost-effectiveness of PPIs in 5 different strategies, namely, continuous (step-up, step-down, and maintenance), on-demand, and intermittent therapies. Results: Of 55 articles published, 10 studies published from 2000 to 2015 were included. Overall, PPIs are more effective in relieving heartburn in comparison with ranitidine. The use of PPIs in managing heartburn in long-term consumption of nonsteroidal anti-inflammatory drug (NSAID) has higher cost compared with H2RA. However, if the decision-maker is willing to pay more than US$174 788.60 per extra quality-adjusted life year (QALY), then the optimal strategy is traditional NSAID (tNSAID) and PPIs. The probability of being cost-effective was also highest for NSAID and PPI co-therapy users. On-demand PPI treatment strategy showed dominant with an incremental cost-effectiveness ratio of US$2197 per QALY gained and was most effective and cost saving compared with all the other treatments. The average cost-effectiveness ratio was lower for rabeprazole therapy than for ranitidine therapy. Conclusion: Our review revealed that long-term treatment with PPIs is effective but costly. To achieve long-term cost-effective approach, we recommend on-demand approach to treat heartburn symptoms, but if the symptoms persist, treatment with continuous step-down therapy should be applied.

A cluster randomized trial to measure the impact on nonsteroidal anti-inflammatory drug and proton pump inhibitor prescribing in Italy of distributing cost-free paracetamol to osteoarthritic patients

BackgroundParacetamol is recommended as first-line treatment for pain control in osteoarthritis because it has fewer side effects than do other therapeutic options, including nonsteroidal anti-inflammatory drugs (NSAIDs). Prescribing proton pump inhibitors (PPIs) as gastric bleeding prophylaxis in chronic NSAID users is also common, although not recommended. In Italy, paracetamol is not reimbursed by the National Health System. The aim of this trial was to test whether the availability to osteoarthritis patients of free paracetamol would decrease their use of NSAIDs and, as a secondary objective, whether opioid and PPI consumption would also decrease.MethodsEight general practitioners (GPs) (59 patients) were randomized to usual care and 8 (58 patients) to the experimental arm, where prescribed paracetamol was directly distributed for free by the local hospital. After 6 months, paracetamol was also available for free in the control arm.The main outcome was the pre/post difference in average NSAID and PPI consumption. Differences between experimental and control arms in pre/post differences are reported, as registered by the drug prescription information system.ResultsAverage NSAID consumption decreased non-significantly, from 6.79 to 2.16 defined daily dose (DDD) in the experimental arm and from 3.19 to 2.97 DDD in the control group (p = 0.067). No changes were observed for PPIs (from 11.27 to 14.65 DDD and from 9.74 to 12.58 DDD in experimental and control arms, respectively, p = 0.788) or opioids (from 1.61 to 1.14 DDD and from 1.41 to 1.56 DDD in experimental and control arms, respectively, p = 0.419). When the intervention was extended to the control arm, no decrease in NSAID consumption was observed (from 2.46 to 2.43 DDD, p = 0.521).ConclusionsRemoving small economic barriers had small or no effect on the appropriateness of opioid or PPI prescribing to patients with osteoarthritis; a reduction in NSAID consumption cannot be ruled out.Trial registration numberNCT02691754 (Approved February 24, 2016).

A latent class based imputation method under Bayesian quantile regression framework using asymmetric Laplace distribution for longitudinal medication usage data with intermittent missing values

ABSTRACTEvaluating the association between diseases and the longitudinal pattern of pharmacological therapy has become increasingly important. However, in many longitudinal studies, self-reported medication usage data collected at patients’ follow-up visits could be missing for various reasons. These pieces of missing or inaccurate/untenable information complicate determining the trajectory of medication use and its complete effects for patients. Although longitudinal models can deal with specific types of missing data, inappropriate handling of this issue can lead to a biased estimation of regression parameters especially when missing data mechanisms are complex and depend upon multiple sources of variation. We propose a latent class-based multiple imputation (MI) approach using a Bayesian quantile regression (BQR) that incorporates cluster of unobserved heterogeneity for medication usage data with intermittent missing values. Findings from our simulation study indicate that the proposed method performs better than traditional MI methods under certain scenarios of data distribution. We also demonstrate applications of the proposed method to data from the Prospective Study of Outcomes in Ankylosing Spondylitis (AS) cohort when assessing an association between longitudinal nonsteroidal anti-inflammatory drugs (NSAIDs) usage and radiographic damage in AS, while the longitudinal NSAID index data are intermittently missing.

Is anemia a clinical marker of NSAIDs-induced upper gastrointestinal lesions in patients with spondyloarthritis?

Background: Anemia is a frequent comorbid conditions in patients with spondyloarthritis (SpA). Its development is associated with the activity of the underlying disorder, and in some cases can be a complication of medical treatment. Investigation into the particulars of the anemia, its prevalence in SpA patients is of considerable interest due to the long-term inflammatory process, on the one hand, and high frequency of non-steroidal anti-inflammatory drugs (NSAIDs) usage, on the other.Aim: To assess the incidence of NSAID-induced lesions of upper gastrointestinal tract in patients with SpA and anemia.Materials and methods: This cross-sectional observational study included 107 patients with proven SpA (mean age, 44 [36; 53] years; SpA duration, 16 [9; 21] years; men, 61.9%) who were treated in the Department of Rheumatology, Saratov Regional Clinical Hospital, from 2017 to 2018. We assessed their blood cell counts, C-reactive protein levels, iron kinetic parameters (serum iron, transferrin, ferritin, transferrin saturation). Anemia was diagnosed according to the World Health Organization criteria. Two groups were formed depending on the presence of absolute iron deficiency: group 1, 13 patients with anemia of chronic disease (ACD), group 2, 3 patients with iron deficiency anemia (IDA) and 26 patients with ACD + IDA. Esophagogastroduodenoscopy (EGDS) was performed to assess mucous membranes of the upper gastrointestinal tract in patients with anemia.Results: Anemia was found in 42 (39.3%) patients, 38 (90.5%) of them had mild anemia. The increase in the activity of the underlying disorder judged by changes in the laboratory markers of systemic inflammation (erythrocyte sedimentation rate and C-reactive protein levels) significantly correlated with a decrease in hemoglobin concentration (r = -0.5715 and r = -0.3498 respectively, p&lt;0.05). At EGDS, NSAIDs-induced erosions in the esophagus and/or stomach were found detected in 1 (7.7%) patient of the group 1 and in 1 (3.4%) patient of the group 2. A past episode of NSAIDs-induced erosions in the stomach and duodenum was noted in 4 (13.8%) patients of the group 2, whereas at the time of the study no mucous membranes defects were found at EGDS.Conclusion: Anemia was found in more than one third of SpA patients, with 29 of them (69%) having laboratory signs of iron deficiency, but only 1 (3.4%) patient had NSAIDs-induced gastropathy confirmed at EGDS. NSAIDs-associated enteropathy could be the cause of iron deficiency in these patients that would require additional patient examination. The development of iron deficiency can be pathophysiologically associated to prolonged inhibition of alimentary iron absorption against the background of persistent systemic inflammation and depletion of the iron pool in the absence of gastrointestinal blood losses.

Risk of Recurrent Peptic Ulcer Disease in Patients Receiving Cumulative Defined Daily Dose of Nonsteroidal Anti-Inflammatory Drugs.

The purpose of this population-based case–control study was to clarify the impact of cumulative dosage of nonsteroidal anti-inflammatory drugs (NSAIDs) on recurrent peptic ulcers among chronic users after Helicobacter pylori (H. pylori) eradication. We analyzed data of 203,407 adult peptic ulcer disease (PUD) patients from the National Health Insurance Research Database in Taiwan entered between 1997 and 2013. After matching for age/gender frequencies and the length of follow-up time in a ratio of 1:1, the matched case–control groups comprised 1150 patients with recurrent PUD and 1150 patients without recurrent PUD within 3 years of follow-up. More recurrent PUDs occurred in NSAID users than in the control group (75.30% versus 69.74%; p = 0.0028). Independent risk factors for recurrent PUD included patients using NSAIDs (adjusted OR (aOR): 1.34, p = 0.0040), H. pylori eradication (aOR: 2.73; p < 0.0001), concomitant H2 receptor antagonist (aOR: 1.85; p < 0.0001) and anti-coagulant (aOR: 4.21; p = 0.0242) use. Importantly, in the initial subgroup analysis, the risk ratio of recurrent PUD did not increase in NSAID users after H. pylori eradication compared with that in non-users (p = 0.8490) but a higher risk for recurrent PUD with the increased doses of NSAIDs without H. pylori eradication therapy (aOR: 1.24, p = 0.0424; aOR: 1.47, p = 0.0074; and aOR: 1.64, p = 0.0152 in the groups of ≤28, 29–83, and ≥84 cumulative defined daily doses, respectively). The current study suggested that H. pylori eradication therapy could decrease the risk of recurrent PUD among patients with high cumulative doses of NSAIDs.

Berberine ameliorates non-steroidal anti-inflammatory drugs-induced intestinal injury by the repair of enteric nervous system.

The study was to detect the role of GDNF, PGP9.5 (a neuronal marker), and GFAP (EGCs' marker) in the mechanism of non-steroidal anti-inflammatory drugs (NSAIDs) related to intestinal injury and to clarify the protective effect of berberine in the treatment of NSAID-induced small intestinal disease. Forty male SD rats were divided randomly into five groups (A-E): Group A: control group; Group B: model group received diclofenac sodium 7.5mg/(kg*day) for 5days; Group C-E: berberine low, medium and high dose groups were treated by 7.5mg/(kg*day) diclofenac sodium for 5days then received berberine 25mg/(kg*day), 50mg/(kg*day), and 75mg/(kg*day), respectively, between the sixth and eighth day. Intestinal mucosa was taken on the ninth day to observe the general, histological injuries, and to measure the intestinal epithelial thickness. Then, immunohistochemistry was performed to detect the expression of PGP9.5 and GFAP, and Western blot was performed to detect GDNF expression. The histological score and the general score in the model group were, respectively, 5.75±1.04 and 4.83±0.92. Scores in berberine medium and high berberine group were lower compared with the model group (P<0.05). The intestinal epithelial thickness in the model group was lower than in the control group and the berberine groups (P<0.05). PGP9.5, GFAP, and GDNF content in the model group and the three berberine groups were significantly lower than in the control groups (P<0.05). PGP9.5, GFAP, and GDNF content in the control group and the three berberine groups were higher compared with the model groups (P<0.05). Berberine can protect the intestinal mucosa of NSAID users, and the mechanism is associated with the reparation of the enteric nervous system via upregulating the expression of PGP9.5, GFAP, and GDNF.

2927 A Prospective Longitudinal Study of Acetaminophen/NSAIDs Effect on Inflammatory Bowel Disease Flares and Activity

INTRODUCTION: It is well established that non-steroidal anti-inflammatory drug (NSAID) users are more likely to have intestinal inflammation/damage. There have been several conflicting studies about the effect of acetaminophen and NSAIDs on inflammatory bowel disease (IBD). We hypothesized that acetaminophen/NSAID use is associated with increased IBD flares and activity. This study was aimed to assess the effect of acetaminophen/NSAIDs on IBD flares and activity. METHODS: We conducted a prospective longitudinal study of Veterans from the IBD clinic at the Michael E. DeBakey VA Medical Center from 2014 to 2018. Our eligibility criteria included patients who were at least 18 years of age, who were diagnosed with Crohn's Disease (CD) or Ulcerative Colitis (UC), and who had at least 1 clinic visit. IBD flare was defined by patient self-report of IBD flare between clinical encounters. IBD activity was quantified using the partial Mayo Score (pMayo) for UC, and the Harvey Bradshaw Index (HBI) for CD. Remission was defined by pMayo &lt;2 for UC and HBI &lt;5 for CD. Acetaminophen/NSAID exposure was assessed via surveys during clinical encounters. Associations of Acetaminophen/NSAID use with IBD flare and activity were assessed using T-tests and Chi-squared tests. RESULTS: A total of 132 patients were included in the analysis of which 74 had CD and 58 had UC. 43 patients were acetaminophen users, 43 patients were NSAID users, and IBD flares occurred in 60 patients. No significant associations between Acetaminophen/NSAID usage and IBD flares were observed: Acetaminophen/NSAID users who developed a flare was 41.9% and 55.8% respectively while 54.5% non-users developed a flare. UC patients using acetaminophen/NSAIDs were associated with significant increases in pMayo compared with UC patients not using acetaminophen/NSAIDs (acetaminophen: 1.71- &gt;2.91, P-value = 0.003; NSAIDs: 1.81- &gt;2.60, P-value = 0.034). In patients with UC, acetaminophen use was associated with non-remission status (RR 1.96; 95% CI 1.29-2.97). CONCLUSION: Amongst UC patients, acetaminophen/NSAID usage was not associated with interval flare however was associated with increased disease activity and non-remission status. In CD patients, no significant associations between Acetaminophen/NSAID use with flare or activity were observed. Counseling patients on decreasing acetaminophen/NSAID usage may decrease disease severity in patients with UC.

1226 Under-Utilization of Proton Pump Inhibitors in the Prevention of NSAID-Related Peptic Ulcer Disease in the Elderly

INTRODUCTION: Peptic ulcer disease (PUD) develops in approximately 25% of chronic users of non-steroidal anti-inflammatory drugs (NSAIDs). The incidence of uncomplicated PUD has been declining over the past 3 decades unlike that of complicated PUD especially in the elderly. We aimed to evaluate physician compliance with the American College of Gastroenterology (ACG) guidelines on the prevention of NSAID-related PUD complications in a tertiary academic setting. METHODS: We examined the Saint Louis University Hospital medical record database for a 9-month period extending from April 2018 until December 2018. Using this database, we identified 2,064 adult elderly patients (&gt;64 years old) who were chronic (&gt;3 months) users of low dose aspirin (81 mg once daily). We performed a retrospective analysis of patients who were at least on aspirin and had an indication for PUD prophylaxis as per ACG guidelines. Data collected from patient charts included age, gender, relevant medications (including proton pump inhibitors (PPI), aspirin, P2Y12 inhibitors, direct oral anticoagulants (DOACs), warfarin, or oral steroids), and whether prophylaxis was provided as per the ACG guidelines. RESULTS: A total of 301 adult elderly patients who were at least on aspirin and had an indication for PUD prophylaxis were identified in this study. The mean age was 75 years old. Six percent of included patients had a history of peptic ulcer disease. In addition to aspirin, patients were using P2Y12 inhibitors (clopidogrel or ticagrelor, 50%), DOACs (24%), warfarin (11%), or steroids (9%). DOAC users were prescribed apixaban (16%), rivaroxaban (7%), or dabigatran (1%) (Table 1). All antiplatelets, anticoagulants, and steroids were prescribed by non-gastroenterologists. Only 35% of patients with an indication for PUD prophylaxis received a PPI. The prophylaxis rates were highest for patients with a history of peptic ulcer disease (62%) and were lowest for users of P2Y12 inhibitors (29%). There were no statistically significant age or gender related differences in the rates of compliance when independent sample t and chi square tests were performed (Table 1). CONCLUSION: Peptic ulcer disease prophylaxis with proton pump inhibitors may be underutilized in elderly patients. This finding, along with increasing rates of NSAID use and aging population, may help explain the increased incidence of complicated PUD in the elderly. Efforts are needed to raise physician awareness of PUD prophylaxis guidelines.

Laparoscopic versus Open Repair of Perforated Peptic Ulcer

Background: H. pylori infection and nonsteroidal anti-inflammatory drug (NSAID) usage contribute to a great majority of cases. Thus, non-operative management of the disease is indicated in nearly all cases, with the exceptions of hemorrhage, perforation, obstruction, and refractory disease. Objective: Comparison between laparoscopic and open repair of perforated peptic ulcer as regards postoperative advantage and complication. Patients and methods: 279 identified published observational studies (randomized control trials and clinical control trials) after search strategy. Participants were patients that had done repairing of perforated peptic ulcer. Laparoscopic versus open repair of perforated peptic ulcer. Results: There was no significant difference in the operating time between the two groups (p Z 0.618). Overall, the laparoscopic group had fewer complications compared to the open group (14.3% vs. 36.8%, p Z 0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p Z 0.003). The other parameters were not statistically significant. Although total hospital costs were similar (P = .465), the median intraoperative costs were greater for LR than for OR patients, at U6772 and U5626, respectively (P < .001). The median cost of ward stay tended to be U865 less in the LR group but was not statistically relevant. Conclusion: Laparoscopic surgery had upper hand over open procedure because of less intraoperative blood loss and postoperative pain, less postoperative complications, shorter hospital stay, surgical site infection rate, shorter nasogastric tube duration.

Analgesic drug use in elderly persons: A population-based study in Southern Italy.

IntroductionAnalgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), weak and strong opioids are commonly used among elderly persons. The aim of this study was to describe the demographic and clinical characteristics of elderly analgesic users and to measure the frequency of analgesic use, including the frequency of potentially inappropriate analgesic use.MethodsThe Arianna database was used to carry out this study. This database contains prescription data with associated indication of use for 1,076,486 inhabitants registered with their general practitioners (GPs) in the Caserta Local Health Unit (Caserta district, Campania region in Italy). A cohort of persons aged ≥65 years old with >1 year of database history having at least one analgesic drug (NSAIDs, strong or weak opioids) between 2010 and 2014 were identified. The date of the first analgesic prescription in the study period was considered the index date (ID).ResultsFrom a source population of 1,076,486 persons, 116,486 elderly persons were identified. Of these, 94,820 elderly persons received at least one analgesic drug: 36.6% were incident NSAID users (N = 36,629), while 13.2% were incident weak opioid users (N = 12,485) and 8.1% were incident strong opioid users (N = 7,658). In terms of inappropriate analgesic use, 9.2% (N = 10,763) of all elderly users were prescribed ketorolac/indomethacin inappropriately, since these drugs should not be prescribed to elderly persons. Furthermore, at least half all elderly persons with chronic kidney disease or congestive heart failure were prescribed NSAIDs, while these drugs should be avoided.ConclusionAnalgesics are commonly used inappropriately among elderly persons, suggesting that prescribing practice in the catchment area may yet be improved.

Non-steroidal anti-inflammatory drugs use in older adults decreases risk of Alzheimer's disease mortality.

Alzheimer disease (AD) mortality risk in a large cohort of subjects treated or not with non-steroidal anti-inflammatory drugs (NSAIDs) is unknown. Our objective was to determine whether NSAIDs use is associated with decreased risk of AD mortality. In this prospective, population-based study (Neurological Disorders in Central Spain [NEDICES]) of 5,072 people without AD (aged 65 years and older), sociodemographic, comorbidity factors, and current medications were recorded at baseline. Community-dwelling older adults were followed for a median of 12.7 years, after which the death certificates of deceased participants were examined. 2,672 (52.7%) of 5,072 participants died, including 504 (18.9%) NSAIDs users and 2,168 (81.1%) non-users. Of the 2,672 deceased participants, 113 (4.2%) had AD as a cause of death (8 [1.6%] among NSAIDs users and 105 [4.8%] among non-users, chi-square = 10.70, p = 0.001). In an unadjusted Cox model, risk of AD mortality was decreased in NSAIDs users (hazard ratio [HR] for AD mortality = 0.35, 95% confidence interval [CI] 0.17–0.72, p = 0.004) when compared to non-users. After adjusting for numerous demographic factors and co-morbidities, the HR for AD mortality in NSAIDs users was 0.29, 95% CI 0.12–0.73, p = 0.009. Stratified analyses showed a significantly decreased risk of AD mortality with aspirin, whereas non-aspirin NSAIDs only showed a statistical trend toward significance in the adjusted Cox regression models. NSAIDs use was associated with 71% decreased risk of AD mortality in older adults. Our results support the hypothesis that NSAIDs use is a protective factor of developing AD.