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Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.
J Clin Gastroenterol. 2016 Feb; 50(2):152-6.JC

Abstract

GOALS

To determine the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in activation of inflammatory bowel disease (IBD).

BACKGROUND

NSAIDs may activate inflammatory pathways in IBD.

STUDY

Crohn's and Colitis Foundation of American Partners is an ongoing cohort study of patients living with IBD. All data are self-reported using the internet. We identified a subcohort of participants whose disease activity, based on short Crohn's Disease Activity Index and simple clinical colitis activity index, indicated remission. Pattern of use of NSAIDs was measured at baseline, and disease activity assessment was performed 6 months later. We used multivariate binomial regression to determine effects of NSAIDs on disease activity.

RESULTS

A total of 791 individuals in remission had baseline and follow-up data available for analysis. Of these, 247 Crohn's disease (CD) patients (43.2%) and 89 ulcerative colitis (UC) patients (40.6%) reported NSAID use. CD patients with NSAID use ≥5 times/month had greater risk of active disease at follow-up (23% vs. 15%, P=0.04); [adjusted risk ratio (RR), 1.65; 95% confidence interval (CI), 1.12-2.44). No effect was observed in patients with UC (22% vs. 21%, P=0.98; adjusted RR, 1.25; 95% CI, 0.81-1.92). Acetaminophen use was associated with active disease at follow-up in CD (adjusted RR, 1.72; 95% CI, 1.11-2.68).

CONCLUSIONS

Regular (≥5 times/mo) NSAID and acetaminophen use were associated with active CD, but not UC. Less frequent NSAID use was not associated with active CD or UC. These findings indicate that regular NSAID use may increase CD activity, or that NSAID use may be a marker of a less robust remission; thus reflecting subclinical disease activity.

Authors+Show Affiliations

*Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC †Geisel School of Medicine at Dartmouth, Hanover, NH.No 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

Language

eng

PubMed ID

26485106

Citation

Long, Millie D., et al. "Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease." Journal of Clinical Gastroenterology, vol. 50, no. 2, 2016, pp. 152-6.
Long MD, Kappelman MD, Martin CF, et al. Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. J Clin Gastroenterol. 2016;50(2):152-6.
Long, M. D., Kappelman, M. D., Martin, C. F., Chen, W., Anton, K., & Sandler, R. S. (2016). Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. Journal of Clinical Gastroenterology, 50(2), 152-6. https://doi.org/10.1097/MCG.0000000000000421
Long MD, et al. Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. J Clin Gastroenterol. 2016;50(2):152-6. PubMed PMID: 26485106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease. AU - Long,Millie D, AU - Kappelman,Michael D, AU - Martin,Christopher F, AU - Chen,Wenli, AU - Anton,Kristen, AU - Sandler,Robert S, PY - 2015/10/21/entrez PY - 2015/10/21/pubmed PY - 2016/12/15/medline SP - 152 EP - 6 JF - Journal of clinical gastroenterology JO - J Clin Gastroenterol VL - 50 IS - 2 N2 - GOALS: To determine the role of nonsteroidal anti-inflammatory drugs (NSAIDs) in activation of inflammatory bowel disease (IBD). BACKGROUND: NSAIDs may activate inflammatory pathways in IBD. STUDY: Crohn's and Colitis Foundation of American Partners is an ongoing cohort study of patients living with IBD. All data are self-reported using the internet. We identified a subcohort of participants whose disease activity, based on short Crohn's Disease Activity Index and simple clinical colitis activity index, indicated remission. Pattern of use of NSAIDs was measured at baseline, and disease activity assessment was performed 6 months later. We used multivariate binomial regression to determine effects of NSAIDs on disease activity. RESULTS: A total of 791 individuals in remission had baseline and follow-up data available for analysis. Of these, 247 Crohn's disease (CD) patients (43.2%) and 89 ulcerative colitis (UC) patients (40.6%) reported NSAID use. CD patients with NSAID use ≥5 times/month had greater risk of active disease at follow-up (23% vs. 15%, P=0.04); [adjusted risk ratio (RR), 1.65; 95% confidence interval (CI), 1.12-2.44). No effect was observed in patients with UC (22% vs. 21%, P=0.98; adjusted RR, 1.25; 95% CI, 0.81-1.92). Acetaminophen use was associated with active disease at follow-up in CD (adjusted RR, 1.72; 95% CI, 1.11-2.68). CONCLUSIONS: Regular (≥5 times/mo) NSAID and acetaminophen use were associated with active CD, but not UC. Less frequent NSAID use was not associated with active CD or UC. These findings indicate that regular NSAID use may increase CD activity, or that NSAID use may be a marker of a less robust remission; thus reflecting subclinical disease activity. SN - 1539-2031 UR - https://www.unboundmedicine.com/medline/citation/26485106/Role_of_Nonsteroidal_Anti_Inflammatory_Drugs_in_Exacerbations_of_Inflammatory_Bowel_Disease_ DB - PRIME DP - Unbound Medicine ER -