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Systematic review: the lower gastrointestinal adverse effects of non-steroidal anti-inflammatory drugs Laine L; Smith R; Min K; Chen C; Dubois RWAliment Pharmacol Ther 2006[Sep]; 24 (5): 751-67BACKGROUND: Lower gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs) are much more poorly characterized than upper gastrointestinal effects. AIM: To determine if NSAIDs increase lower gastrointestinal adverse effects and if the risk with non-selective NSAIDs is greater than with cyclooxygenase-2-selective inhibitors (coxibs). METHODS: Computerized databases were searched to identify studies of NSAID use reporting on lower gastrointestinal integrity (e.g. permeability), visualization (e.g. erosions, ulcers) and clinical events. RESULTS: Designs in 47 studies were randomized (18), case-control (14), cohort (eight) and before-after (seven). Non-selective-NSAIDs had significantly more adverse effects vs. no NSAIDs in 20 of 22 lower gastrointestinal integrity studies, five of seven visualization studies, seven of 11 bleeding studies (OR: 1.9-18.4 in case-control studies), two of two perforation studies (OR: 2.5-8.1) and five of seven diverticular disease studies (OR: 1.5-11.2). Coxibs had significantly less effect vs. non-selective-NSAIDs in three of four integrity studies, one endoscopic study (RR mucosal breaks: 0.3), and two randomized studies (RR lower gastrointestinal clinical events: 0.5; haematochezia: 0.4). CONCLUSIONS: An increase in lower gastrointestinal injury and clinical events with non-selective-NSAIDs appears relatively consistent across the heterogeneous collection of trials. Coxibs are associated with lower rates of lower gastrointestinal injury than non-selective-NSAIDs. More high-quality trials are warranted to more precisely estimate the effects of non-selective-NSAIDs and coxibs on the lower gastrointestinal tract.|Anti-Inflammatory Agents, Non-Steroidal/*adverse effects[MESH]|Cyclooxygenase 2 Inhibitors/adverse effects[MESH]|Diverticulum/chemically induced[MESH]|Gastrointestinal Hemorrhage/chemically induced[MESH]|Humans[MESH]|Inflammation/chemically induced[MESH]|Intestinal Diseases/*chemically induced[MESH]|Intestine, Large/drug effects/physiopathology[MESH]|Intestine, Small/drug effects/physiopathology[MESH]|Lower Gastrointestinal Tract[MESH]|Permeability/drug effects[MESH] |
