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Do Steroids Cause Upper GI Complications?

It is widely assumed that oral corticosteroid therapy predisposes patients to upper gastrointestinal (UGI) ulceration, but not all studies have reached this conclusion. These researchers used the large U.K. General Practice Research Database to reexamine the association.

The researchers identified 2105 patients with gastric or duodenal bleeding or perforation; cases were compared with 11,500 age- and sex-matched controls. About 5 percent of cases and 2 percent of controls were current oral-steroid users; after adjustments for numerous confounding variables, including previous ulcer and current use of nonsteroidal anti-inflammatory drugs (NSAIDs), steroid use was associated with a significantly higher risk for UGI complications (odds ratio, 1.8). The higher risk was noted with both short-term and long-term steroid use. In the study cohort, the odds ratios for UGI complications were 4.0 among users of NSAIDs alone and 8.9 among users of both steroids and NSAIDs.

Comment: In this study, oral-steroid therapy conferred a roughly 2-fold higher risk of UGI bleeding and perforation; risk increased dramatically with concurrent NSAID use. The researchers found no increased risk associated with past use of oral steroids, which suggests that the underlying diseases associated with steroid therapy did not confound these results.

— AS Brett

Published in Journal Watch General Medicine June 29, 2001

Citation(s):

Hernandez-Diaz S and Rodriguez LAG. Steroids and risk of upper gastrointestinal complications. Am J Epidemiol 2001 Jun 1 153 1089-1093.

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