Table 2: Survey to assess the knowledge of Internal Medicine trainees (by year of training) of the gastrointestinal complications in patients who take chronic NSAIDs.
PGY-1 (n = 61) | PGY-2 (n = 26) | PGY-3 (n = 31) | PGY-4 (n = 5) | |
Please select what you believe are the three most important risk factors for NSAID-related GI complications | ||||
History of gastric or duodenal ulcer | 46 | 16 | 26 | 2 |
History of bleeding ulcer | 39 | 18 | 17 | 4 |
Age > 65 | 14 | 9 | 4 | 1 |
Use of Aspirin | 10 | 3 | 3 | 0 |
Use of anticoagulants (NOACs, Warfarin) and anti-platelet agents (clopidogrel) | 14 | 13 | 12 | 3 |
History of H. Pylori infection | 6 | 3 | 3 | 0 |
Smoking History | 7 | 1 | 3 | 0 |
Dyspepsia History | 6 | 2 | 1 | 0 |
Alcohol Abuse | 8 | 3 | 4 | 1 |
High dose NSAID use | 41 | 15 | 20 | 3 |
Use of Corticosteroids | 8 | 6 | 9 | 1 |
When do you believe is the risk of NSAID-associated GI complications such as gastric/duodenal ulcers, the highest? | ||||
During the first week | 5 | 0 | 2 | 1 |
1-2 weeks after administration | 15 | 8 | 11 | 1 |
2-4 weeks after administration | 8 | 8 | 4 | 1 |
> 4 weeks after administration | 35 | 10 | 14 | 2 |
Which gastroprotective agent would you prescribe if you felt the patient was at risk for developing GI complications from NSAIDs? | ||||
Misoprostol | 8 | 2 | 0 | 0 |
PPI such as Prilosec, Prevacid, Dexilent, Protonix | 42 | 16 | 23 | 5 |
H2 receptor antagonist such as Pepcid, Zantac | 12 | 10 | 8 | 0 |
Of this list of NSAIDs, pick the three medications that you believe would cause the least amount of GI complications? | ||||
Diclofenac | 21 | 6 | 15 | 2 |
Etodolac | 4 | 2 | 3 | 1 |
Ibuprofen | 20 | 10 | 5 | 1 |
Indomethacin | 17 | 5 | 4 | 0 |
Ketorolac | 15 | 11 | 16 | 2 |
Meloxicam | 16 | 3 | 3 | 2 |
Naproxen | 19 | 9 | 5 | 0 |
Oxaprozin | 7 | 3 | 2 | 1 |
Tolmetin | 7 | 2 | 5 | 1 |
Celecoxib | 43 | 22 | 25 | 3 |
Of this list of NSAIDs, which three do you think cause the most GI side effects? | ||||
Diclofenac | 15 | 9 | 7 | 0 |
Etodolac | 4 | 3 | 0 | 1 |
Ibuprofen | 26 | 13 | 19 | 3 |
Indomethacin | 27 | 9 | 17 | 3 |
Ketorolac | 30 | 15 | 18 | 1 |
Meloxicam | 11 | 4 | 4 | 1 |
Naproxen | 29 | 13 | 18 | 3 |
Oxaprozin | 9 | 1 | 1 | 1 |
Tolmetin | 4 | 1 | 0 | 0 |
Celecoxib | 9 | 5 | 2 | 0 |
Regarding NSAID use I tell my patients to | ||||
Take NSAIDs on a full stomach | 46 | 22 | 23 | 4 |
Avoid taking NSAIDs 1 hour before bedtime | 5 | 6 | 3 | 2 |
Take an over the counter PPI with their NSAID always | 7 | 2 | 2 | 0 |
Take an over the counter PPI with their NSAID sometimes | 10 | 7 | 12 | 4 |
Take an over the counter PPI with their NSAID never | 4 | 1 | 2 | 0 |