Use
of Selective Serotonin Reuptake Inhibitors and Risk of Upper
Gastrointestinal Bleeding:
A Systematic Review and Meta-analysis
Received:
January 3, 2014;
Received in revised form:
June 15, 2014;
Accepted:
June 18, 2014;
Published Online: June 30, 2014
Clinical Gastroenterology and Hepatology
Backgroud & Aims
Selective
serotonin reuptake inhibitors (SSRIs) are used to treat various
psychiatric disorders. However, there are concerns that SSRIs increase
risk for upper gastrointestinal bleeding (UGIB).
Methods
We
performed a systematic review and meta-analysis of controlled
observational studies to determine whether SSRI use affects risk for
UGIB. Our analysis included all observational studies that compared UGIB
development among patients receiving SSRIs versus no treatment. We
calculated pooled odds ratios (ORs) using random–and fixed effects
model.
Results
A total of 22 studies
(6 cohort and 16 case–control studies) involving over 1,073,000
individuals were included in our meta-analysis. In comparing SSRI users
with patients who had not taken SSRIs, the odds for developing UGIB were
1.55 fold higher (odds ratio [OR] =1.55, 95% confidence interval
[CI]=1.35-1.78). In subgroup analyses, the association was greatest for
patients who received concurrent therapy with non-steroid
anti-inflammatory or antiplatelet drugs; we found no significant
increase in the risk of developing UGIB among patients receiving
concurrent acid-suppressing drugs.
Conclusions
SSRI
use associated with an almost 2-fold increase in the risk of developing
UGIB-especially among patients at high risk for GI bleeding (concurrent
use of non-steroid anti-inflammatory or antiplatelet drugs). This risk
might be significantly reduced by concomitant use of acid-suppressing
drugs.
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