Investigating the Use of Gastroprotectants as a Means of Preventing Iatrogenic Gastrointestinal Signs Associated With Immunosuppressive Corticosteroid Therapy. A Retrospective Study

Abstract

Background: Gastroprotectants are commonly prescribed in patients receiving immunosuppressive therapy with glucocorticoids. Presently, there is limited evidence to support such use of gastroprotectants.

Objectives: To establish if the prophylactic use of gastroprotectants was associated with a reduced incidencer of gastrointestinal signs in dogs receiving immunosuppressive doses of glucocorticoids, compared to not receiving prophylactic gastroprotectants.

Methods: Retrospective observational study. The case log of a University referral hospital was examined between September 2009 and September 2015 for dogs diagnosed with primary, immune-mediated disease. Those receiving ≥1mg/kg/day prednisolone or equivalent as part of their treatment were included. Dogs displaying gastrointestinal signs (vomiting, diarrhoea, regurgitation or haematochezia) in the preceding 7 days or those diagnosed with immune-mediated thrombocytopenia were excluded. Statistical significance was P<0.05.

Results: One hundred and twenty-seven dogs were enrolled. All dogs received prednisolone; median (range) dose 2 (1- 4.4) mg/kg/day. Seventy-six dogs received a gastroprotectant. Sixty-three dogs received them concurrent to glucocorticoids (“prophylactic” group) and thirteen dogs received gastroprotectants after starting glucocorticoids, without experiencing gastrointestinal signs (“post-exposure” group). Fifty-one dogs received no gastroprotectants (“no gastroprotectant” group). Overall 34/127 (26.8%) dogs developed gastrointestinal signs; 8/51 (15.7%) in the “no gastroprotectant” group and 26/76 (34.2%) of dogs receiving gastroprotectants. This difference was significant (P= 0.016) between groups. There was no significant difference between the “prophylactic group” (18/63; 28.6%) and “post-exposure” group (8/13; 61.5%), or between the “prophylactic” and “no gastroprotectant” groups in the incidence of gastrointestinal signs.

Conclusions: Gastroprotectants are associated with a higher incidence of gastrointestinal signs and conferred no identifiable benefits. Prospective randomised trials are required to validate these findings.