Underutilization of gastroprotective drugs in patients receiving non-steroidal anti-inflammatory drugs

Dig Liver Dis. 2011 Mar;43(3):209-14. doi: 10.1016/j.dld.2010.09.009. Epub 2010 Nov 3.


Aim: To assess the prevalence of gastroprotective agent prescription in patients treated with non-steroidal anti-inflammatory drugs in France and to analyze the determinants of this prescription.

Methods: A cross-sectional observational study was performed in 2576 patients treated with non-steroidal anti-inflammatory drugs recruited prospectively in the French primary care system.

Results: Thirty-nine percent of the patients (n=1002) received gastroprotective agents, mostly proton pump inhibitors (99.5%). In patients with a single risk factor, the gastroprotection rates were: 50% for age>65, 67% for concurrent use of corticosteroids or antithrombotics, and 87% and 100% for history of uncomplicated and complicated gastroduodenal ulcers. In patients without risk factors, gastroprotective agents were prescribed in 31.8%. Among them, two thirds had symptoms of gastro-oesophageal reflux or history of non-steroidal anti-inflammatory drug intolerance or dyspepsia. Conversely, 40% (n=256) of at-risk non-steroidal anti-inflammatory drug users did not receive gastroprotective agents. Gastroprotection was significantly associated with history of gastroduodenal ulcer (OR: 8.2; 95%CI: 4.3-15.6) or history of non-steroidal anti-inflammatory drug intolerance (OR: 6; 95%CI: 4.5-8.1), gastro-oesophageal reflux (OR: 6; 95%CI: 4.4-8.2), dyspepsia (OR: 5.2; 95%CI: 3.7-7.5), concurrent gastrotoxic treatment (OR: 3.3; 95%CI: 1.9-5.6) and age>65 (OR: 3; 95%CI: 2.3-4.1).

Conclusions: Despite widespread recommendations, gastroprotection is still largely underprescribed in patients at risk of gastrointestinal non-steroidal anti-inflammatory drug complications in France. Only half of non-steroidal anti-inflammatory drug users above 65 years are prescribed gastroprotective agents.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anti-Ulcer Agents
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data*
  • Drug Utilization / statistics & numerical data
  • Dyspepsia / epidemiology
  • Dyspepsia / prevention & control
  • Female
  • France
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / prevention & control
  • Gastrointestinal Agents*
  • Gastrointestinal Diseases / epidemiology
  • Gastrointestinal Diseases / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Peptic Ulcer / epidemiology
  • Peptic Ulcer / prevention & control
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prospective Studies
  • Proton Pump Inhibitors
  • Risk Factors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anti-Ulcer Agents
  • Gastrointestinal Agents
  • Proton Pump Inhibitors