Gastrointestinal bleeding after the introduction of COX 2 inhibitors: ecological study.

Recent evidence suggests a lower risk of upper gastrointestinal haemorrhage for selective cyclooxygenase-2 (COX 2) inhibitors compared with non-selective non-steroidal anti-inflammatory drugs (NSAIDs) at the patient level, although COX 2 inhibitors are likely not devoid of gastrointestinal toxicity. At the population level, however, the widespread proliferation of COX 2 inhibitors might lead to an increase in the overall numbers of people exposed to anti-inflammatory drugs with uncertain implications on rates of population-wide gastrointestinal events. We did an ecological study to examine temporal changes in the use of NSAIDs and upper gastrointestinal haemorrhage hospitalisation rates among a population of older individuals after the introduction of COX 2 inhibitors.