Katsuhiro Toda
A narrative review was conducted to examine whether acetaminophen caused upper gastrointestinal complications (UGIC). A small case control study reported that odds ratio (OR) for the risk of upper gastrointestinal (GI) bleeding with was 1.2 (3,250 mg/day) were more likely to experience GI event compared with those who took low-dose acetaminophen (≦ 2,600 mg/day) (RR 1.27: 1.13–1.43 and RR 1.34: 1.15–1.54, respectively). A population-based retrospective cohort study showed that the risk of GI hospitalization was 1.20 (1.03-1.40) during exposure to acetaminophen (>3g/day) compared with the reference category (acetaminophen ≤3 g/day). It is reasonable to judge that acetaminophen>2,000 mg/day causes UGIC. If acetaminophen>2,000 mg/day is administered, gastroprotective agent is probably necessary. We don’t know which gastroprotective agent is optimal. Proton pump inhibitors (PPIs) cause many serious adverse effects. PPIs prevent UGIC due to acetaminophen; however, PPIs exacerbate lower GI complications. If gastroprotective agent is necessary, rebamipide is recommended as a first-line therapy. It is hoped that evidence about these issues will be reported and guidelines will be published.
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