A SURVIVING MYTH

Scand J Gastroenterol. 2010 Jun 22. [Epub ahead of print]
"A surviving myth" - corticosteroids are still considered ulcerogenic by a majority of physicians *
Martínek J, Hlavova K, Zavada F, Seifert B, Rejchrt S, Urban O, Zavoral M.

Department of Internal Medicine of the First Medical Faculty and Central Military Hospital, Charles University, Prague, Czech Republic.
Abstract

Abstract Objective. Evidence does not support an association between systemic corticosteroid use and the development of peptic ulcer disease (PUD) and prophylactic anti-ulcer therapy is not routinely indicated. The aim was to find out the opinion of physicians in the Czech Republic on corticosteroid-induced ulcers. Materials and methods. A questionnaire-based study targeting 360 physicians of different specialties (100 from Gastroenterology, 100 from General Practice, 80 from Pneumology/Immunology, and 80 from Neurology/Neurosurgery). Results. Eighty-two percent of the physicians considered corticosteroids ulcerogenic, 7.5% of the responders considered them ulcerogenic only in patients with a family history of PUD, and 10.3% of the physicians considered corticosteroids non-ulcerogenic. Seventy-five percent of the responders would administer concomitant antisecretory treatment. Sixty-seven percent of the physicians thought that PUD was a frequent complication of corticosteroid therapy. If the ulcerogenic potential of ibuprophene, diclofenac, and prednisone was a subject of the physicians' judgment, a majority (40.5%) considered prednisone to be the most ulcerogenic substance. Thirty percent of gastroenterologists (vs. 1.9% of others; p < 0.001) did not consider corticosteroids to be ulcerogenic; 27.4% (vs. 4.3%; p < 0.01) would not administer an antisecretory prophylaxis routinely. Conclusions. Although there is no evidence showing an association between PUD and the use of corticosteroids, a majority of physicians consider corticosteroids gastrotoxic. This applies, to a lesser extent, to gastroenterologists. Action should be taken to explode the myth about the gastrotoxicity of corticosteroids and to minimize useless expenses on concomitant prophylaxis.