Selective serotonin reuptake inhibitors and gastrointestinal bleeding: a case-control study

• Published in: PloS one Vol. 6; no. 5; p. e19819
• Main Authors: Carvajal, Alfonso, Ortega, Sara, Del Olmo, Lourdes, Vidal, Xavier, Aguirre, Carmelo, Ruiz, Borja, Conforti, Anita, Leone, Roberto, López-Vázquez, Paula, Figueiras, Adolfo, Ibáñez, Luisa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18-05-2011; Public Library of Science (PLoS)
• Subjects: Adolescent; Adult; Age composition; Antidepressants; Antidepressive Agents - pharmacology; Bleeding; Case-Control Studies; Drug dosages; Drugs; Endoscopy; Female; Gastrointestinal hemorrhage; Gastrointestinal Hemorrhage - drug therapy; Hemorrhage; Humans; Inhibitors; Italy; Male; Medical research; Medicine; Middle Aged; Nervous system; Patients; Pharmacology; Phenols (Class of compounds); Risk Factors; Selective serotonin reuptake inhibitors; Serotonin; Serotonin uptake inhibitors; Serotonin Uptake Inhibitors - pharmacology; Sex; Spain; Studies; Suicides & suicide attempts; Surgery; Toxicology; Tricyclic antidepressants; Ulcers; Young Adult; Italy; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0019819

Selective serotonin reuptake inhibitors (SSRIs) have been associated with upper gastrointestinal (GI) bleeding. Given their worldwide use, even small risks account for a large number of cases. This study has been conducted with carefully collected information to further investigate the relationship between SSRIs and upper GI bleeding.
We conducted a case-control study in hospitals in Spain and in Italy. Cases were patients aged ≥18 years with a primary diagnosis of acute upper GI bleeding diagnosed by endoscopy; three controls were matched by sex, age, date of admission (within 3 months) and hospital among patients who were admitted for elective surgery for non-painful disorders. Exposures to SSRIs, other antidepressants and other drugs were defined as any use of these drugs in the 7 days before the day on which upper gastrointestinal bleeding started (index day).
581 cases of upper GI bleeding and 1358 controls were considered eligible for the study; no differences in age or sex distribution were observed between cases and controls after matching. Overall, 4.0% of the cases and 3.3% of controls used an SSRI antidepressant in the week before the index day. No significant risk of upper GI bleeding was encountered for SSRI antidepressants (adjusted odds ratio, 1.06, 95% CI, 0.57-1.96) or for whichever other grouping of antidepressants.
The results of this case-control study showed no significant increase in upper GI bleeding with SSRIs and provide good evidence that the magnitude of any increase in risk is not greater than 2.