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  • Title: [A NSAID-associated alimentary tract disease in patients with rheumatism in Russia].
    Author: Karataev AE, Konovalova NN, Litovshenko AA, Lomareva NI, Nemtsov BF, Raskina TA, Peshekhonova LK, Nasonov EL.
    Journal: Klin Med (Mosk); 2005; 83(5):33-8. PubMed ID: 15984580.
    Abstract:
    The aim of the study was to evaluate the prevalence and character of non-steroid antiinflammatory drug (NSAID)-associated pathology in patients with rheumatic diseases (RD) in the Russian population. The study included questioning of 2537 RD patients (81% women and 19% men, mean age 55.8 +/- 14.2 years) who were taking NSAID, in 6 regions of Russia, between the October of 2003 and April of 2004. The results were analyzed using chi2 criterion, Fisher exact test, and Student t-criterion. 7.6% of the questioned and 14.7% of their relatives had ulcerous background [corrected] history (ulcers diagnosted prior to the beginning of treatment with NSAID). Most patients (70.1%) were taking non-selective NSAID (NSNSAID), chiefly diclophenac (50.9%). The most often used non-selective cyclooxygenasa-2 (COG-2) inhibitor was nimesulid, taken by 23.5% of the patients. 20.2% of patients were not aware of the influence of NSAID on the gastric and intestinal mucosa. 33.7% of the patients underwent esophagogastroduodenoscopy (EGDS) while taking NSAID. In 8.8% of the examined gastric or duodenal ulcers were found while they were taking NSAID; 1.5% of the examined developed gastro-duodenal hemorrhage or ulcer perforation. 53.1% of the questioned had gastroduodenal complaints; in most cases it was heartburn (37.3%), "heaviness" in the epigastral area (37.4%), and meteorism (37.4%). 51.3% of the patients associated gastroesopagial reflux and dyspepsia symptoms with intake of NSAID. 26.9% of the questioned associated stool disturbances and meteorism with NSAID intake. 32% of the patients took medications to eliminate gastrointestinal disorder symptoms. Patients taking selective COG-2 inhibitors had complaints less frequently than those who were taking NSNSAID (p = 0). Most frequently complaints were associated with intake of glucocorticoids (p = 0), low doses of aspirin (p = 0), smoking (p = 0), and elderly age (p = 0.007). Appearance of complaints was not associated with the dose of NSAID (diclophenac) (p = 0.257). 8.8% of the patients with ulcerous background were not aware of the effects of NSAID on the alimentory tract; 34.1% of the patients din not undergo EGDS withing the period of treatment with NSAID. Only 40.3% of patients were taking selective COG-2 inhibitors; 54.7% of patients were taking gastroprotective preparations. Alimentary tract pathology is a prevalent complication of therapy with NSAID in the Russian population. The most frequent gastrointestinal symptoms are subjective; they affect life quality substantially. Their risk factors are: elderly age, ulcer background, and glucocorticoid intake. Russian doctors do not take sufficient measures to prevent serious NSAID intake complications.
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