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Meta-Analysis
. 2018 Jun;47(11):1428-1439.
doi: 10.1111/apt.14606. Epub 2018 Apr 5.

Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation

O O Moninuola  1 , W Milligan  2 , P Lochhead  3 , H Khalili  3   4
Affiliations
Meta-Analysis

Systematic review with meta-analysis: association between acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and risk of Crohn's disease and ulcerative colitis exacerbation

O O Moninuola et al. Aliment Pharmacol Ther. 2018 Jun.

Abstract

Background: Unlike acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) have generally been thought to be associated with increased risk of IBD exacerbation.

Aim: To carry out a systematic review and meta-analysis of previous studies examining the association between acetaminophen and NSAIDs including cyclooxygenase (COX-2) inhibitors use, and risk of Crohn's disease (CD) and ulcerative colitis (UC) exacerbation.

Methods: We identified published manuscripts and abstracts through 1 March 2017 by systematic search of Medline, Embase, Cochrane and other trial registries. Quality assessment was done using Newcastle-Ottawa scale and random-effect meta-analysis using pooled relative risks (RRs) and 95% CIs were calculated.

Results: Eighteen publications between years 1983 and 2016 were identified. For the meta-analysis, pooled RRs of disease exacerbation with NSAIDs use were (1.42, 95% CI, 0.65-3.09), I2 = 60.3% for CD, and (1.52, 95% CI, 0.87-2.63), I2 = 56.1% for UC. The corresponding values for acetaminophen use were (1.40, 95% CI, 0.96-2.04), I2 = 45.6% for UC, and (1.56, 95% CI, 1.22-1.99), I2 = 0.0% for IBD. Sensitivity analyses limited to studies with low risk of bias showed a significantly increased risk of CD exacerbation (1.53, 95% CI, 1.08-2.16) but not UC (0.94, 95% CI, 0.36-2.42) with NSAIDs use.

Conclusions: Contrary to generally accepted belief, we did not find a consistent association between NSAIDs use and risk of CD and UC exacerbation. There was also no consistent evidence for association with acetaminophen although further studies are needed.

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Conflict of interest statement

Conflict of Interest:

None to declare

Figures

Figure 1
Figure 1
Flow Diagram of Eligible Studies
Figure 2
Figure 2
Meta-Analysis of NSAIDs Use and Risk of IBD Exacerbation
Figure 3
Figure 3
Meta-Analysis of Acetaminophen Use and Risk of IBD Exacerbation
Figure 4
Figure 4
Meta-Analysis of NSAIDs Use and Risk of IBD Exacerbation Among Studies with Low Risk of Bias
Figure 5
Figure 5
Meta-Analysis of NSAIDs Use and Risk of IBD Exacerbation Among Cohort Studies
See this image and copyright information in PMC

References

    1. Hirschowitz BI. Nonsteroidal antiinflammatory drugs and the gastrointestinal tract. Gastroenterologist. 1994;2(3):207–23. - PubMed
    1. Sostres C, Gargallo CJ, Lanas A. Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage. Arthritis Research & Therapy. 2013;15(Suppl 3):S3–S3. - PMC - PubMed
    1. Laine L. Nonsteroidal anti-inflammatory drug gastropathy. Gastrointest Endosc Clin N Am. 1996;6(3):489–504. - PubMed
    1. 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;156(5):350–9. - PMC - PubMed
    1. Gleeson MH, Davis AJ. Non-steroidal anti-inflammatory drugs, aspirin and newly diagnosed colitis: a case-control study. Aliment Pharmacol Ther. 2003;17(6):817–25. - PubMed

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