Physicians' approaches to the use of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users

Aliment Pharmacol Ther. 2006 May 1;23(9):1365-72. doi: 10.1111/j.1365-2036.2006.02873.x.


Background: Many doctors unnecessarily prescribe gastroprotective strategies to non-steroidal anti-inflammatory drugs users at low risk of non-steroidal anti-inflammatory drug-related gastrointestinal complications.

Aim: To identify factors that predict the overuse of gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users.

Methods: We distributed a questionnaire to family doctors and general internists consisting of a clinical vignette describing a low-risk hypothetical patient with osteoarthritis who was a candidate for non-steroidal anti-inflammatory drug therapy. Respondents were asked whether they would prescribe this patient a gastroprotective strategy and to estimate the annual risk of that patient developing a gastrointestinal complication with non-steroidal anti-inflammatory drug use. Respondents inappropriately recommending a gastroprotective strategy were compared with respondents who opted not to use gastroprotection.

Results: We received 340 responses (response rate of 28.3%), of which 278 supplied analysable data. Thirty-five percent of respondents inappropriately recommended a gastroprotective strategy for the low-risk subject. Inappropriate prescribers were significantly more likely to overestimate the risk of gastrointestinal complications with traditional non-steroidal anti-inflammatory drugs and this was strongly predictive of gastroprotective strategy recommendation in logistic regression.

Conclusions: Many doctors inappropriately recommend gastroprotective strategies in low-risk non-steroidal anti-inflammatory drug users. Improving doctors' awareness of non-steroidal anti-inflammatory drug-associated gastrointestinal risks may lead to a decrease in inappropriate utilization of gastroprotective strategies in low-risk patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Inflammatory Agents, Non-Steroidal / economics
  • Clinical Competence
  • Cyclooxygenase 2 Inhibitors / economics
  • Cyclooxygenase 2 Inhibitors / therapeutic use*
  • Family Practice / standards
  • Female
  • Gastrointestinal Diseases / chemically induced
  • Gastrointestinal Diseases / economics
  • Gastrointestinal Diseases / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Professional Practice / standards*
  • Proton Pump Inhibitors*
  • Proton Pumps / economics
  • Risk Factors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Cyclooxygenase 2 Inhibitors
  • Proton Pump Inhibitors
  • Proton Pumps