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Aspirin, nonsteroidal anti-inflammatory drug use, and risk for Crohn disease and ulcerative colitis: a cohort study.
Ann Intern Med 2012; 156(5):350-9AIM

Abstract

BACKGROUND

Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory but have been linked in some studies to Crohn disease (CD) and ulcerative colitis (UC).

OBJECTIVE

To assess the association between aspirin and NSAID use and incident CD and UC.

DESIGN

Prospective cohort study.

SETTING

Nurses' Health Study I.

PATIENTS

76,795 U.S. women who provided biennially updated data about aspirin and NSAID use.

MEASUREMENTS

Incident CD and UC between 1990 and 2008 (outcome) and NSAID and aspirin use (exposure).

RESULTS

123 incident cases of CD and 117 cases of UC occurred over 18 years and 1,295,317 person-years of follow-up. Compared with nonusers, women who used NSAIDs at least 15 days per month seemed to have increased risk for both CD (absolute difference in age-adjusted incidence, 6 cases per 100,000 person-years [95% CI, 0 to 13]; multivariate hazard ratio, 1.59 [CI, 0.99 to 2.56]) and UC (absolute difference, 7 cases per 100,000 person-years [CI, 1 to 12]; multivariate hazard ratio, 1.87 [CI, 1.16 to 2.99]). Less frequent NSAID use was not clearly associated with risk for CD or UC, and there was no clear association between aspirin use and disease.

LIMITATIONS

Cohort participants were exclusively women, most of whom were white. Aspirin and NSAID use were self-reported.

CONCLUSION

Frequent use of NSAIDs but not aspirin seemed to be associated with increased absolute incidence of CD and UC. The findings have more mechanistic than clinical implications, because the absolute incidence of CD or UC associated with NSAIDs was low and the increase in risk for CD or UC associated with NSAIDs is unlikely to alter the balance of more common and clinically significant risks and benefits associated with these agents.

PRIMARY FUNDING SOURCE

American Gastroenterological Association, IBD Working Group, Broad Medical Research Program, and National Institutes of Health.

Authors+Show Affiliations

Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22393130

Citation

Ananthakrishnan, Ashwin N., et al. "Aspirin, Nonsteroidal Anti-inflammatory Drug Use, and Risk for Crohn Disease and Ulcerative Colitis: a Cohort Study." Annals of Internal Medicine, vol. 156, no. 5, 2012, pp. 350-9.
Ananthakrishnan AN, Higuchi LM, Huang ES, et al. Aspirin, nonsteroidal anti-inflammatory drug use, and risk for Crohn disease and ulcerative colitis: a cohort study. Ann Intern Med. 2012;156(5):350-9.
Ananthakrishnan, A. N., Higuchi, L. M., Huang, E. S., Khalili, H., Richter, J. M., Fuchs, C. S., & Chan, A. T. (2012). Aspirin, nonsteroidal anti-inflammatory drug use, and risk for Crohn disease and ulcerative colitis: a cohort study. Annals of Internal Medicine, 156(5), pp. 350-9. doi:10.7326/0003-4819-156-5-201203060-00007.
Ananthakrishnan AN, et al. Aspirin, Nonsteroidal Anti-inflammatory Drug Use, and Risk for Crohn Disease and Ulcerative Colitis: a Cohort Study. Ann Intern Med. 2012 Mar 6;156(5):350-9. PubMed PMID: 22393130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aspirin, nonsteroidal anti-inflammatory drug use, and risk for Crohn disease and ulcerative colitis: a cohort study. AU - Ananthakrishnan,Ashwin N, AU - Higuchi,Leslie M, AU - Huang,Edward S, AU - Khalili,Hamed, AU - Richter,James M, AU - Fuchs,Charles S, AU - Chan,Andrew T, PY - 2012/3/7/entrez PY - 2012/3/7/pubmed PY - 2012/4/17/medline SP - 350 EP - 9 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 156 IS - 5 N2 - BACKGROUND: Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory but have been linked in some studies to Crohn disease (CD) and ulcerative colitis (UC). OBJECTIVE: To assess the association between aspirin and NSAID use and incident CD and UC. DESIGN: Prospective cohort study. SETTING: Nurses' Health Study I. PATIENTS: 76,795 U.S. women who provided biennially updated data about aspirin and NSAID use. MEASUREMENTS: Incident CD and UC between 1990 and 2008 (outcome) and NSAID and aspirin use (exposure). RESULTS: 123 incident cases of CD and 117 cases of UC occurred over 18 years and 1,295,317 person-years of follow-up. Compared with nonusers, women who used NSAIDs at least 15 days per month seemed to have increased risk for both CD (absolute difference in age-adjusted incidence, 6 cases per 100,000 person-years [95% CI, 0 to 13]; multivariate hazard ratio, 1.59 [CI, 0.99 to 2.56]) and UC (absolute difference, 7 cases per 100,000 person-years [CI, 1 to 12]; multivariate hazard ratio, 1.87 [CI, 1.16 to 2.99]). Less frequent NSAID use was not clearly associated with risk for CD or UC, and there was no clear association between aspirin use and disease. LIMITATIONS: Cohort participants were exclusively women, most of whom were white. Aspirin and NSAID use were self-reported. CONCLUSION: Frequent use of NSAIDs but not aspirin seemed to be associated with increased absolute incidence of CD and UC. The findings have more mechanistic than clinical implications, because the absolute incidence of CD or UC associated with NSAIDs was low and the increase in risk for CD or UC associated with NSAIDs is unlikely to alter the balance of more common and clinically significant risks and benefits associated with these agents. PRIMARY FUNDING SOURCE: American Gastroenterological Association, IBD Working Group, Broad Medical Research Program, and National Institutes of Health. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/22393130/Aspirin_nonsteroidal_anti_inflammatory_drug_use_and_risk_for_Crohn_disease_and_ulcerative_colitis:_a_cohort_study_ L2 - https://www.annals.org/aim/fullarticle/doi/10.7326/0003-4819-156-5-201203060-00007 DB - PRIME DP - Unbound Medicine ER -