Upper gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs in African-American and Hispanic elderly patients.

OBJECTIVES To determine the upper gastrointestinal (UGI) toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs), in African-American and Hispanic elderly patients. SETTING Inner-city community hospital. METHODS Retrospective review of records of 698 patients, 65 to 101 years old. Upper gastrointestinal (UGI) symptoms and history of NSAIDs consumption were recorded over a 12-year period. Twenty White and 25 Asian patients were excluded. Another 101 patients were excluded because of incomplete data or because endoscopy was not performed. Patients were stratified as NSAID-users or non-users, and the data were analyzed. RESULTS Among the 552 patients, the most common lesion was gastro-duodenal erosions (34%), while common symptoms were abdominal pain (71%) and bleeding (54%). Both lesions and symptoms were higher among NSAID-users than non-users (P<.05). Endoscopic therapy was given to 296 patients, and was successful in stopping the bleeding and/or delaying surgery in 70% of the patients. Helicobacter pylori tests were done in 238 patients, and were positive in 47% of the patients. Overall 144 deaths occurred (26%). Mortality was significantly higher among elderly patients who used NSAIDs compared to those who did not use them (P<.05). CONCLUSIONS Our study suggests a higher association between NSAID use and UGI toxicity than is reported in current literature. Patients suffering from UGI toxicity of NSAIDs may remain asymptomatic until complications occur, therefore a high index of suspicion and a low threshold for endoscopy are essential, especially in elderly patients. Avoiding NSAIDs whenever possible, substituting less toxic COX-2 inhibitors, monitoring risk, and providing cotherapy with proton pump inhibitors (PPI), or misoprostol, as suggested in the literature, may decrease NSAIDs associated morbidity and mortality in this patient population.