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Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Objective

This population-based survey was conducted to provide a formal description of upper gastrointestinal bleeding (UGIB) in children on a nationwide basis and assess the contribution of risk factors, principally nonsteroidal anti-inflammatory drugs (NSAID).

Methods

A case-crossover study of UGIB patients aged between 2 months and 16 years was conducted in France. Medical data were collected by physicians, and personal risk factors and exposure to drugs during the month preceding the onset of the bleeding was ascertained by a standardised telephone interview with parents. The odds ratios for UGIB and NSAID was assessed by comparing exposure during the 7 days preceding the date of hospitalisation and the 21st to the 28th days before that date.

Results

A total of 177 children with UGIB were included over 2 years. Eighty-three children had taken at least one NSAID before the index date, among which 58 were ibuprofen, 26 aspirin and nine others. The adjusted odds ratio (OR) of exposure was 8.2 [95% confidence interval (CI) 2.6–26.0] for NSAIDs altogether, and this was 10.0 (95% CI 2.0–51.0) for ibuprofen and 7.3 (95% CI 0.9–59.4) for aspirin. There was no increased risk associated with NSAIDS for oesophageal lesion [OR = 1.0 [(5% CI:0.2–7.2)].

Conclusion

The study confirms that UGIB is rare but that some cases may be avoided, as one third of the cases was attributable to exposure to NSAID at doses used for analgesic or antipyretic purposes, which may be attained with alternative therapy. The findings from this study call for more caution in prescribing NSAIDS to children.

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Acknowledgements

The authors thank Richard Medeiros (Rouen University Hospital Medical Editor) for editing the manuscript.

Funds

This study was supported by research grants from the French Agency of Medical Security of Health Products (AFSSAPS).

Conflict of interest statements

None of the authors have financial or personal relationships, academic competition or intellectual commitments that might bias the work or interfere with objective judgment.

Access to data

Lamiae Grimaldi-Bensouda, Elisabeth Autret-Leca and Benoit David had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Authors and Affiliations

  1. Inserm U657 “Pharmacoepidemiology Unit”, Paris, France

    Lamiae Grimaldi-Bensouda & Lucien Abenhaim

  2. LA-SER, alpha network, Pepiniere Paris Sante Cochin, 29 rue du Faubourg Saint-Jacques, 75014, Paris, France

    Lamiae Grimaldi-Bensouda & Benoît David

  3. London School of Hygiene and Tropical Medicine, London, UK

    Lucien Abenhaim

  4. Department of Paediatric Gastroenterology, Jeanne de Flandre Hospital, France, Avenue Eugène Avinée, 59037, Lille Cedex, France

    Laurent Michaud

  5. Department of Paediatrics, Rouen University Hospital, France, 1 rue de Germont, 76031, Rouen Cedex, France

    Olivier Mouterde

  6. Department of Pharmacology, Tours University Hospital, France, 2 boulevard Tonnellé, 37044, Tours cedex 9, France

    Annie Pierre Jonville-Béra & Elisabeth Autret-Leca

  7. Inserm CIC 202, France; François Rabelais University Tours, France; Tours University Hospital, France, 2 bis boulevard Tonnellé, 37032, Tours cedex 1, France

    Bruno Giraudeau

  8. Department of Pharmacology, François Rabelais University Tours, Tours, France

    Elisabeth Autret-Leca

  9. Service de Pharmacologie Clinique - CHRU de Tours, 2 boulevard Tonnelle, 37044, Tours cedex 9, France

    Elisabeth Autret-Leca

Authors
  1. Lamiae Grimaldi-Bensouda
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  2. Lucien Abenhaim
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  3. Laurent Michaud
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  4. Olivier Mouterde
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  5. Annie Pierre Jonville-Béra
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  6. Bruno Giraudeau
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  7. Benoît David
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  8. Elisabeth Autret-Leca
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Corresponding author

Correspondence to Elisabeth Autret-Leca.

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Grimaldi-Bensouda, L., Abenhaim, L., Michaud, L. et al. Clinical features and risk factors for upper gastrointestinal bleeding in children: a case-crossover study. Eur J Clin Pharmacol 66, 831–837 (2010). https://doi.org/10.1007/s00228-010-0832-3

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  • DOI: https://doi.org/10.1007/s00228-010-0832-3

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