Variation in the risk of peptic ulcer complications with nonsteroidal antiinflammatory drug therapy

Arthritis Rheum. 1993 Jan;36(1):84-90. doi: 10.1002/art.1780360114.


Objective: To assess the risk of perforation or hemorrhage of peptic ulcer on treatment with nonsteroidal antiinflammatory drugs (NSAIDs), both as a class and as individual agents.

Methods: A case-control study of medication histories in 494 patients and 972 matched control subjects.

Results: The increase in risk (odds ratio) with NSAID therapy was 5.1 times the risk in controls. The odds ratio for piroxicam was 6.3 (95% confidence interval [CI] 3.3-12.0), as compared with 2.9 for diclofenac, ketoprofen, and sulindac combined (95% CI 2.0-4.2). The effect of other risk factors was also considered, and the adjusted odds ratios were 4.1 for all NSAIDs, 6.4 (95% CI 2.8-15.0) for piroxicam, and 3.3 (95% CI 2.0-5.5) for diclofenac, ketoprofen, and sulindac combined.

Conclusion: The estimate of overall risk of peptic ulcer complications with NSAIDs is similar to that found in other studies. There appear to be differences in risk between agents.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Cohort Studies
  • Humans
  • Middle Aged
  • Peptic Ulcer / complications*
  • Peptic Ulcer / epidemiology
  • Peptic Ulcer Hemorrhage / chemically induced
  • Peptic Ulcer Perforation / chemically induced
  • Risk Factors
  • Sex Factors
  • Stomach Ulcer / complications


  • Anti-Inflammatory Agents, Non-Steroidal