Abstract

A profile of patients on ASA or NSAIDs hospitalized with gastrointestinal perforations

BACKGROUND: In a recent clinical trial gastrointestinal tract perforations in patients on nonsteroidal anti-inflammatory drugs (NSAIDs) were found to occur with a frequency of 0.15%, and possibly to be reduced in patients concomitantly using the cytoprotective agent misoprostol.
OBJECTIVE: To characterize patients with gastrointestinal perforations admitted to the two major referral teaching hospitals in Edmonton, Alberta between January 1, 1989 and December 31, 1993.
METHODS: A computerized search program was used to select patient charts containing preselected International Classification of Diseases (ICD) 9-CM codes, and patients were organized into four study groups based upon drug use: those taking NSAIDs, those taking acetylsalicylic acid (ASA), those taking both NSAIDs and ASA, and those taking neither NSAIDs nor ASA.
RESULTS: The following significant characteristics were identified in the 428 patients admitted with perforations: only a minority (29%) were taking either NSAIDs or ASA; NSAID users were likely to be female, while those using neither NSAID nor ASA were more likely to be male; females were older than males; patients taking NSAIDs, ASA or both were more often asymptomatic at presentation compared with those not using these drugs; and upper gastrointestinal tract perforations were more likely to occur in the duodenum than in the stomach, while lower gastrointestinal tract perforations were more likely to occur in the colon than in the small intestine.
CONCLUSIONS: This retrospective descriptive study outlines the profile of a patient presenting to a referral hospital with a gastrointestinal perforation. Furthermore, it suggests that NSAID and/or ASA use significantly alters this profile compared with that in patients using neither NSAIDs nor ASA.