Lanas A, Esplugues JV, Zapardiel J, Sobreviela E. Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications. World J Gastroenterol 2009; 15(47): 5953-5959 [PMID: 20014459 DOI: 10.3748/wjg.15.5953]
Corresponding Author of This Article
Dr. Angel Lanas, Service of Digestive Diseases, University Hospital, University of Zaragoza, Instituto Aragonés de Ciencias de la Salud (IACS), Centros de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), C/San Juan Bosco 15, 50009 Zaragoza, Spain. alanas@unizar.es
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Brief Article
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World J Gastroenterol. Dec 21, 2009; 15(47): 5953-5959 Published online Dec 21, 2009. doi: 10.3748/wjg.15.5953
Table 1 A summary of the main questions (from a total of 22) assessing physicians’ knowledge of current evidence in the field of NSAID use and adverse effects
NSAID use is associated with adverse effects. Which of the following do you believe is not associated with NSAID use?
What is the expected annual incidence of upper GI complications in patients taking NSAIDs, as reported in the most recent large outcome studies?
The occurrence of dyspepsia in patients who take NSAIDs has been reported to be less than 25% (true or false)
NSAIDs may induce GI complications in the lower GI tract (true or false)
Which of the following factors do you believe is/are risk factors for GI complications in patients who take NSAIDs? (list)
Which of the following NSAIDs do you believe is more toxic to the GI tract? (list)
Concerning COX-2 selective inhibitors, for each of the following, indicate whether the statement is true or false:
They are not as effective as traditional NSAIDs in the treatment of OA or RA
The use of these compounds is associated with a 50% reduction in the risk of GI complications compared to NSAIDs
The concomitant use of low-dose aspirin reduces or eliminates the GI benefit of these compounds when compared to NSAIDs
The use of these compounds has been associated with an increased risk of CV events
In high-risk patients, the combination of NSAIDs plus a PPI is safer than a coxib alone
Concerning gastroprotective agents, indicate for each of the following statements whether they are true or false:
H2-RAs are effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications
PPIs are effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications
Misoprostol is effective in the prevention of gastric ulcers, duodenal ulcers, and GI complications
Which of the following agents has been proved to be effective in the treatment or prevention of NSAID-induced dyspepsia? (list)
Table 2 Responses to the question, “Which of the following factors do you believe is/are risk factors for GI complications in patients who take NSAIDs”n (%)
Rheumatologists
Orthopedic surgeons
Others
Total
History of peptic ulcer
115 (99.1)
275 (98.2)
21 (100.0)
411 (98.6)
History of complicated peptic ulcer
116 (100.0)
275 (98.2)
21 (100.0)
412 (98.8)
Age > 65 yr
114 (98.3)
229 (81.8)
18 (90.4)
361 (86.6)
Concomitant use of low-dose aspirin for CV prevention
114 (98.3)
228 (81.4)
19 (90.4)
361 (86.6)
Concomitant use of anticoagulants
112 (96.5)
247 (88.2)
20 (95.3)
379 (90.9)
Helicobacter pylori infection
103 (88.8)
257 (91.8)
19 (90.4)
379 (90.9)
Smoking
87 (75.00)
223 (79.6)
13 (61.7)
323 (77.5)
Dyspepsia history
73 (62.9)
250 (89.3)
19 (90.4)
342 (82.0)
Alcohol
105 (90.5)
257 (91.8)
20 (95.3)
382 (91.6)
High dose of NSAIDs
113 (97.4)
275 (98.2)
21 (100.0)
409 (98.1)
Table 3 Characteristics of patients included in the educational program of the study1n (%)
Variable
Phase I (n = 1732)
Phase II (n = 1722)
Age (mean ± SD)
61.06 ± 13.37
60.81 ± 13.89
Female
1038 (60.4)
980 (57.6)
History of ulcer
238 (13.7)
307 (17.8)
History of ulcer bleeding
61 (3.5)
69 (4.0)
ASA use
167 (9.6)
168 (9.8)
CV history
203 (11.7)
205 (11.9)
Increased blood pressure
845 (48.8)
810 (47.0)
Anticoagulant use
126 (7.3)
120 (7.0)
Corticosteroid use
162 (9.3)
190 (11.0)
History of dyspepsia
782 (45.1)
766 (44.5)
Table 4 Prescription of NSAIDs to patients in each of the two study phases of the educational program n (%)
Table 5 Risk factors (RFs) of patients reported by doctors in the educational program according to either a non-restrictive or a restrictive definition1n (%)
Table 6 Proportion of patients on NSAID therapy that received concomitant therapy with a PPI or misoprostol after the medical visit, according to the number of RFs n (%)
Number of RFs
Non-restrictive
Restrictive
Phase I
Phase II
Phase I
Phase II
0
268/347 (77.2)
283/352 (80.4)
782/961 (81.4)
728/891 (81.7)
1
536/660 (81.2)
499/598 (83.4)
471/558 (84.4)
504/573 (87.9)
2
453/517 (87.6)
456/536 (85.1)
151/176 (85.8)
168/213 (78.9)
> 2
175/208 (84.1)
201/236 (85.2)
28/37 (75.7)
39/45 (86.7)
Citation: Lanas A, Esplugues JV, Zapardiel J, Sobreviela E. Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications. World J Gastroenterol 2009; 15(47): 5953-5959