Drug-induced upper gastrointestinal disorders requiring hospitalization: a five-year study in a South Indian hospital

PURPOSE: To study the clinical spectrum of drug induced upper gastrointestinal tract (GIT) disorders requiring hospitalization and establish the causal relation between drug and disorder using WHO causality definitions. METHODS: Case-records of patients in the Department of Gastroenterology (from January 1998 to December 2002) hospitalized with diagnoses of drug induced upper GIT disorders were analyzed retrospectively. The causality assessment of each disorder was done based on WHO causality definitions. RESULTS: Out of 101 cases identified over the study period, 8 were categorized as certain, 87 as probable and 6 cases as possible. The certain and probable cases (95) were analyzed. Of these, 13 were in 1998, 14 in 1999, 18 in 2000, 20 in 2001 and 30 in 2002. The drug class most commonly implicated with adverse drug reactions was non-steroidal anti-inflammatory drugs (NSAIDs) (76.8%). Among individual drugs, aspirin was most commonly involved (32.6%). Results of endoscopy revealed gastric erosions (40.2%), combination of gastric ulcer and gastric erosions (16.1%), gastric ulcer (15.0%), duodenal ulcer (13.8%), normal (13.8%) and duodenal erosions (1.1%). Risk factors noticed were chronic smoking (16.8%), alcohol consumption (13.7%), smoking and alcohol use (21.1%), history of peptic ulcer (10.5%) and chronic steroid use (1.1%). CONCLUSION: NSAIDs especially aspirin were implicated in maximum number of patients. An increase in occurrence over 5 years, a wide spectrum of disorders and various risk factors were noticed.