Topical Non-steroidal Anti-inflammatory Drugs and Hospitalisation for Upper Gastro-intestinal Bleeding and Perforation: a Record-linkage Case-control Study

Objective: To evaluate the relationship between topically applied non-steroidal antiinflammatory drugs and upper gastro-intestinal bleeding and perforation. Study population: The population of 319,465 people who were resident in Tayside and were registered with a Tayside GP between January 1989 and October 1994. A recordlinkage database containing all hospital event and dispensed drug data between 1989 and 1992 was used for this population. Design: A case-control study with 1,103 cases who were hospitalised for upper gastrointestinal bleeding or perforation between January 1990 and December 1992. Two different control groups were used, with six community controls and with two hospital controls for each case. Prior exposure to topical NSAIDs, oral NSAIDs and ulcer healing drugs was assessed. Main outcome measures: Unadjusted and adjusted odds ratios of exposure in hospitalised cases compared with controls. Results: Significant unadjusted associations were detected between all three classes of drug and upper gastro-intestinal complications. The significant association detected for topical NSAIDs was no longer evident in analyses which adjusted for the confounding effect of concomitant exposure to oral NSAIDs and ulcer healing drugs (OR = 1.45, 0.84-2.50 using community controls; OR = 1.06, 0.60-1.88 using hospital controls). Conclusion: In this study, topical NSAIDs were not significantly associated with upper gastro-intestinal bleeding and perforation, after adjusting for the confounding effects of concomitant oral NSAIDs and ulcer healing drugs.