Background and Aim: Non-steroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin (LDA) are the most common causes of drug-induced gastroduodenal ulcer. We investigated preventive treatment with use of concomitant anti-ulcer drugs and the clinical features of gastroduodenal ulcer in cases treated with these drugs.
Method: A total of 2,332 patients with gastroduodenal ulcer and 241 patients with bleeding gastroduodenal ulcer were classified into 3 groups: those taking LDA, those taking non-aspirin NSAIDs (hereinafter referred to as NSAIDs), and those taking neither aspirin nor NSAIDs. Chronological changes in the percentage of each group and the change over the past 15 years were investigated. The status of prevention of ulcer and clinical features were examined in 264 patients with gastroduodenal ulcer taking NSAIDs or LDA, including 107 bleeding cases, in the past 8 years.
Results: From January 2002 to December 2017, the percentage of all patients taking LDA increased until 2013, but from 2014, the percentage of patients taking LDA decreased in those with a bleeding ulcer. The percentage of patients taking NSAIDs decreased from 2002 in those with a bleeding ulcer. Among the 264 patients with gastroduodenal ulcer and the 107 patients with a bleeding ulcer taking NSAIDs and LDA, 16 (6%) and 9 (8%), respectively, were receiving preventive treatment with concomitant anti-ulcer drugs. The percentages of patients taking LDA and other antiplatelet drugs in patients with bleeding gastroduodenal ulcer were significantly higher than those in patients with non-bleeding.
Conclusion: Although the percentages of patients with gastroduodenal ulcer taking NSAIDs or LDA have not recently increased in real-world practice, preventive treatment in these patients is still low. This low rate of prevention in cases of non-bleeding and bleeding gastroduodenal ulcer suggests the need to enlighten physicians about preventive treatment because drug withdrawal of LDA has a high risk of cardiovascular and cerebrovascular events