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Brief use of NSAIDs, steroids linked to upper GI complications in children
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The use of medications, including nonsteroidal anti-inflammatory drugs, oral steroids and antibiotics, even for a short duration, increased the risk for upper gastrointestinal complications in children, according to recent results.
In a multicenter study, researchers evaluated 486 children hospitalized for upper GI complications (UGIC) between November 1999 and November 2010, as well as 1,930 children hospitalized because of neurological disorders serving as controls. Parents were interviewed regarding their child’s exposure to medications within the prior 3 weeks, including nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics and oral steroids, as well as vaccines within the previous 12 weeks.
The UGIC group included 324 patients with hematemesis, 31 with melena and 29 with both, along with 102 patients with gastroduodenal lesions. Children hospitalized for UGIC indicated significantly more drug use than controls (73% of cases compared with 54% of controls, P<.001), and the mean number of drugs used also was significantly higher (1.7 per patient compared with 1.1, P<.001). The duration of drug use ranged from 1 to 8 days, with similar durations across groups for NSAIDs (3 days in cases vs. 2 in controls, P=.41) and steroids (3 days vs. 4, P=.16).
Investigators noted associations between UGIC and the use of NSAIDs (adjusted OR=2.9, 2.1-4.0), oral steroids (aOR=2.9, 1.7-4.8) and antibiotics (aOR=2.3, 1.8-3.1), among others, after adjusting for confounders. Among specific NSAIDs, the risk for UGIC was increased with ibuprofen (aOR=3.7, 2.3-5.9) and ketoprofen (aOR=2.6, 1.2-5.6). Acetaminophen (aOR=2.0, 1.5-2.6) and ibuprofen in combination with acetaminophen (aOR=3.1, 1.5-6.2) (95% CI for all) also raised UGIC risk.
“We provided evidence of an increased risk of UGICs associated with drug use in the pediatric population,” the researchers concluded. “Our study suggests that the absolute risk of UGIC is low; nevertheless, it remains to be determined if all prescriptions were really necessary. The appropriate use of drugs in children should be promoted in order to prevent the occurrence of serious adverse events.”
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