Underutilization of gastroprotective measures in patients receiving nonsteroidal antiinflammatory drugs

Arthritis Rheum. 2002 Aug;46(8):2195-200. doi: 10.1002/art.10425.


Objective: To determine the frequency of use of recommended gastroprotective strategies in a cohort of patients receiving recurrent treatment with nonsteroidal antiinflammatory drugs (NSAIDs).

Methods: A cross-sectional study was performed using administrative data from the Tennessee Medicaid (TennCare) program. The study population consisted of 76,765 recurrent recipients of NSAIDs (NSAID users), comprising 24% of the 319,402 persons ages 50 years or older enrolled in the TennCare program from January 1999 through June 2000. Frequency of use of either of 2 recommended gastroprotective strategies, involving either traditional NSAIDs combined with recommended anti-ulcer cotherapy or use of a selective cyclooxygenase 2-inhibiting drug (coxib), was measured and categorized by risk for ulcer complication.

Results: Among this cohort of recurrent NSAID users, 16% received 1 of the 2 recommended gastroprotective therapies: 10% received traditional NSAIDs along with antiulcer drugs at the recommended doses and 6% received coxibs. Among those patients with > or=2 risk factors for ulcer complications (age 75 years or older, peptic ulcer or gastrointestinal bleeding in the past year, or concurrent use of oral anticoagulants or corticosteroids), 30% received such gastroprotective therapy.

Conclusion: Use of recommended strategies to decrease ulcer complications in vulnerable populations is relatively uncommon.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Ulcer Agents / therapeutic use*
  • Comorbidity
  • Cross-Sectional Studies
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Digestive System / drug effects*
  • Digestive System / pathology
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Peptic Ulcer / chemically induced*
  • Peptic Ulcer / epidemiology
  • Peptic Ulcer / prevention & control*
  • Risk Factors
  • Tennessee / epidemiology


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Cyclooxygenase Inhibitors