Evidence map›Paper›PMID 24833682›Full record

SynthesisBMJ open2014

Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis.

Sigrid Narum, Tone Westergren, Marianne Klemp

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 165 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
165citing papers in PubMed, 7 pooled it
10.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

165 citing papers in PubMed, 7 syntheses or guidelines pooled it, 311 citations in OpenAlex.

  1. Pooled it
  2. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2023
    Guideline
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  8. Trial
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  14. Observational
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  17. Managing bleeds on anticoagulant therapy: a practical guide for clinicians.European heart journal. Acute cardiovascular care · 2026
    Review
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  19. Article
  20. Article

105 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 1 country.

Sigrid NarumCenter for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
Tone WestergrenDepartment of Pharmacology, Regional Medicines Information & Pharmacovigilance Centre (RELIS), Oslo University Hospital, Oslo, Norway.
Marianne KlempNorwegian Knowledge Centre for the Health Services, Oslo, Norway Department of Pharmacology, University of Oslo, Oslo, Norway.
Diakonhjemmet Hospital · NOOslo University Hospital · NOUniversity of Oslo · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess whether corticosteroids are associated with increased risk of gastrointestinal bleeding or perforation.

designSystematic review and meta-analysis of randomised, double-blind, controlled trials comparing a corticosteroid to placebo for any medical condition or in healthy participants. Studies with steroids given either locally, as a single dose, or in crossover studies were excluded. DATA SOURCES: Literature search using MEDLINE, EMBASE and Cochrane Database of Systematic Reviews between 1983 and 22 May 2013. OUTCOME MEASURE: Outcome measures were the occurrence of gastrointestinal bleeding or perforation. Predefined subgroup analyses were carried out for disease severity, use of non-steroidal anti-inflammatory drugs (NSAIDs) or gastroprotective drugs, and history of peptic ulcer.

results159 studies (N=33 253) were included. In total, 804 (2.4%) patients had a gastrointestinal bleeding or perforation (2.9% and 2.0% for corticosteroids and placebo). Corticosteroids increased the risk of gastrointestinal bleeding or perforation by 40% (OR 1.43, 95% CI 1.22 to 1.66). The risk was increased for hospitalised patients (OR 1.42, 95% CI 1.22 to 1.66). For patients in ambulatory care, the increased risk was not statistically significant (OR 1.63, 95% CI 0.42 to 6.34). Only 11 gastrointestinal bleeds or perforations occurred among 8651 patients in ambulatory care (0.13%). Increased risk was still present in subgroup analyses (studies with NSAID use excluded; OR 1.44, 95% CI 1.20 to 1.71, peptic ulcer as an exclusion criterion excluded; OR 1.47, 95% CI 1.21 to 1.78, and use of gastroprotective drugs excluded; OR 1.42, 95% CI 1.21 to 1.67).

conclusionsCorticosteroid use was associated with increased risk of gastrointestinal bleeding and perforation. The increased risk was statistically significant for hospitalised patients only. For patients in ambulatory care, the total occurrence of bleeding or perforation was very low, and the increased risk was not statistically significant.

Indexed as

Adrenal Cortex HormonesGastrointestinal HemorrhageHumansIntestinal PerforationRandomized Controlled Trials as TopicRisk AssessmentStomach RuptureAdrenal Cortex HormonesClinical PharmacologyEpidemiology

Identifiers

PMID24833682
PMCPMC4025450
OpenAlexW2110984144

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.