Alimentary TractGastro-protective strategies in primary care in Italy: The “Gas.Pro.” survey
Introduction
Pharmacological therapy of patients suffering from common disorders such as cardiovascular, rheumatological or post-traumatic/orthopaedic disease is mainly focused on the treatment of the basic condition, the prevention of acute events or the improvement of symptoms. However, particularly for the gastrointestinal (GI) system, the risk of injury is a relevant factor of morbidity and mortality among users of anti-inflammatory agents (both non-steroidal and steroidal), cardiovascular drugs such as antiplatelet agents or anticoagulants, or selective serotonin reuptake inhibitor (SSRI) antidepressants [1], [2], [3], [4]. In addition, the presence of severe comorbidity (especially cardiovascular disease), personal history of complicated peptic ulcer, advanced age, concomitant use of anticoagulants, corticosteroids, combination of NSAIDs and low-dose aspirin or high-dose NSAID therapy, all characterize a subgroup of patients at highest risk of severe GI complications, ranging from ulcer development to haemorrhage or perforation [3], [4], [5], [6].
In order to prevent or reduce the occurrence of such GI complications, adequate gastro-protective agents (GPA) therapy should definitely be endorsed in these high-risk subjects, as recommended by several guidelines [7], [8], [9], [10], [11]. Unfortunately, potential GI side effects are often overlooked or underestimated by primary care physicians (PCP), with studies revealing low levels of GPA co-prescription for non-selective NSAID users in many primary care settings, even among high-risk patients [12], [13]. Moreover, a number of population-based studies carried out in Europe and the U.S. indicate that GPA therapy is often underutilised also by specialists [14], [15], [16].
A nationwide survey was carried out to assess the perceptions and practices of Italian PCPs regarding the use of potentially GI harmful drugs (aspirin, NSAIDs, COX-2 inhibitors, etc.) and their attitude toward gastro-protection strategies.
Section snippets
Methods
The study was performed under the patronage of the Italian Society for Digestive Endoscopy (SIED). Between October and December 2008, a cross-sectional observational study was carried out in cooperation with a group of primary care physicians in Italy. An independent scientific board composed by three expert members of the Italian Society for Digestive Endoscopy was committed to the realization of protocol design and its case report form as well as the supervision of project status.
According to
Demographic and clinical data
A total of 140 primary care physicians throughout Italy were invited and 112 finally agreed to the project (80%). These were subsequently given a set of questionnaires for patient-data collection and completed the investigation, which produced a population survey of 3943 observed cases, with a mean of 35 filled questionnaires/physician.
Mean age of the cohort was 64 ± 15 years, with significant difference between naïve and chronic NSAID/ASA users (61.9 ± 15.5 vs. 69.5 ± 12.4, p = 0.001). In both
Discussion
The implication of chronic NSAID use in the development of severe and potentially life-threatening GI complications is well established. The risk associated with current use is 3.7 (95% CI 3.1–4.3) for conventional NSAIDs and 2.6 (95% CI 1.9–3.6) for Coxibs [2]. The same is true for the use of low-dose ASA for cardio-prophylaxis, associated with a two- to fourfold increase in upper GI adverse events [17]. Dyspeptic symptoms are estimated to occur in 10–60% of NSAIDs users and lead to
Conflict of interest
None declared.
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Cited by (8)
Harmonising proton pump inhibitors treatment in the specialist setting following the SIGE recommendations
2019, Digestive and Liver DiseaseAre the clinical guideline recommendations on gastroprotection being followed? A review in patients taking nonsteroidal anti-inflammatory drugs
2016, Revista de Gastroenterologia de MexicoObservational studies on prescription practices: Interpret with caution
2010, Digestive and Liver DiseaseNonsteroidal anti-inflammatory drugs, gastroprotection, and benefit-risk
2014, Pain PracticeCitation Excerpt :Thus, when considering which gastroprotective therapy to use, we must consider the information learned about adherence to the medications offered. A systematic review of studies of adherence of prescribing gastroprotective agents (GPA) with NSAIDs conducted up to the end of 2005 and including 911,000 NSAID users found that GPAs were prescribed in about 26% of patients taking NSAIDs and having at least one gastrointestinal risk factor, like age, previous ulcers, etc.11 An extension of the search from 2006 to August 2012 identified 21 additional studies (Table 5) with over 1,034,000 additional NSAID users.76–96 As in the earlier systematic review, there was a range of values for the percentage of patients using GPAs with NSAIDs, and this reflects differences in definitions of GPA cover.