“A surviving myth” – corticosteroids are still considered ulcerogenic by a majority of physicians

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.

Key Words::

• Corticosteroids
• peptic ulcer
• proton pump inhibitors

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.