Nonsteroidal anti-inflammatory drug (NSAID) prescribing after gastrojejunostomy: A preventable cause of morbidity

Abby Gross; Corey Gentle; Chase J Wehrle; Kelly Nimylowycz; Sayf Said Al-Deen; Ali Aminian; Toms Augustin

doi:10.1016/j.surg.2024.07.061

Nonsteroidal anti-inflammatory drug (NSAID) prescribing after gastrojejunostomy: A preventable cause of morbidity

Surgery. 2024 Sep 26:S0039-6060(24)00653-6. doi: 10.1016/j.surg.2024.07.061. Online ahead of print.

Authors

Abby Gross¹, Corey Gentle², Chase J Wehrle³, Kelly Nimylowycz⁴, Sayf Said Al-Deen⁴, Ali Aminian⁵, Toms Augustin⁶

Affiliations

¹ Quality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/AbbyRGrossMD.
² Quality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
³ Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/ChaseWehrle.
⁴ Quality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH.
⁵ Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: https://twitter.com/Ali_Aminian_MD.
⁶ Quality Improvement & Patient Safety, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH. Electronic address: [email protected].

PMID: 39332938
DOI: 10.1016/j.surg.2024.07.061

Abstract

Objective: Study findings showing an association between nonsteroidal anti-inflammatory drug use and marginal ulcer, a significant cause of morbidity after gastrojejunostomy, have been inconsistent. This study aimed to evaluate this relationship in large cohort.

Methods: This retrospective cohort included adult patients with a history of gastrojejunostomy documented between 2004 and 2023. The electronic medical record was queried for nonsteroidal anti-inflammatory drug prescriptions, marginal ulcer diagnosis, and comorbidities. Multivariable logistic regression was performed to assess the association between marginal ulcer and nonsteroidal anti-inflammatory drug exposures, controlling for smoking, Helicobacter pylori history, acid-suppressing therapy, diabetes, age, and sex.

Results: During the study period, 6,888 patients with a history of gastrojejunostomy were identified, of whom 45.2% (n = 3,115) of patients were exposed to an nonsteroidal anti-inflammatory drug and 10.12% (n = 697) developed a marginal ulcer. On multivariable analysis, the risk of marginal ulcer was found to be dose-dependent, with increasing odds of marginal ulcer with an increasing number of nonsteroidal anti-inflammatory drug exposures from odds ratio 1.67 (95% confidence interval, 1.37-2.02) with 1-2 nonsteroidal anti-inflammatory drug exposures to odds ratio 2.42 (95% confidence interval, 1.79-3.24) with >8 nonsteroidal anti-inflammatory drug exposures. Acid-suppressing therapy was found to be protective (odds ratio, 0.61; 95% confidence interval, 0.52-0.73). Over the last decade, the number of nonsteroidal anti-inflammatory drugs prescribed to patients with gastrojejunostomy has significantly increased from 15.87 prescriptions per 1,000 patients per year to 531.02 per 1,000 patients per year (R² = 0.91, P < .001).

Conclusion: Marginal ulcer after gastrojejunostomy is associated with nonsteroidal anti-inflammatory drug prescriptions in a dose-dependent manner. Although acid-suppressing therapy appears protective for marginal ulcer, quality improvement efforts should focus on diminishing nonsteroidal anti-inflammatory drug prescribing in this population.