The aim of this study was to compare the frequency of upper gastrointestinal (GI) complaints and complications between chronic rheumatic patients who are most often non-steroidal anti-inflammatory drugs (NSAIDs) users and patients with other chronic conditions. In this comparison we took into account known risk factors for upper GI disease. To achieve the study aims we performed a combined cross-sectional and retrospective study. We therefore interviewed by means of a standard questionnaire, an index and a reference group, about current upper UI complaints and previous complications. The former group comprises 578 outpatients of the Department of Rheumatology, the latter of 531 out patients of the Departments of Internal Medicine, Pulmonology, and Cardiology. Although the number of patients in the index group being chronically treated with NSAIDs was very high (62% versus 9% in the reference group: P<0.00001), no between-group differences were found for the frequency of several current upper gastrointestinal complaints or for the number of upper gastrointestinal investigations ever performed (35% and 37%: NS) or for the use of gastric drugs (14% and 10%: NS). Risk factors for upper GI complaints were not related to NSAID use but with the use of prednisolone, history of duodenal ulcer disease, family history of peptic ulcer disease and female sex. For peptic ulcer disease, bleeding, and gastric surgery, the only difference between the index and reference groups con cerned the frequency of gastric ulcers (6.7p and 2.8p: P<0.005), which was highest in patients with rheumatoid arthritis. Upper GI bleeding had more often been present in male seropositive rheumatoid arthritis patients (1.2% and 4.5%: P<0. 01). Chronic NSAID users do not have a more frequent history of upper GI complaints than patients who do not use NSAIDs. Risk factors for upper GI complaints are associated with the use of prednisolone, history of duodenal ulcer disease, family history of peptic ulcer disease and female sex. The risk of developing gastric ulcers is increased in patients with rheumatological disorders, in particular rheumatoid arthritis patients. The frequency of upper GI bleeding is only increased in male patients with seropositive rheumatoid arthritis.
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Janssen et al. (1992) studied this question.