Clinical symptoms, endoscopic findings and histologic features of gastroduodenal non-steroidal anti-inflammatory drugs lesions
Aabakken, L.
Italian Journal of Gastroenterology and Hepatology 31(Suppl): S19-S22
1999
ISSN/ISBN: 1125-8055 PMID: 10379465 Document Number: 509262
Gastrointestinal side effects of non-steroidal anti-inflammatory drugs are among the most prevalent iatrogenic gastrointestinal problems, due to the prevalence of problems, but even more because of the large and increasing population that is exposed. Dyspeptic complaints are prevalent, and cause discontinuation of the drug in 10% of patients. These symptoms fail, however, to correlate with endoscopic findings, and cannot be used to monitor patients for serious adverse events. The interventional measures include dose reduction, administration with food, concomitant use of antiacids or antisecretory drugs. Sometimes, changing the drug can help. Non-steroidal anti-inflammatory gastropathy comprises petechiae, haemorrhagic erosions and mucosal erythema. Such lesions are prevalent even in short term studies, but the clinical significance is uncertain, since an extrapolation to serious adverse events has not been documented. Histologically, a "chemical gastritis" has been described, but others fail to distinguish convincingly between Helicobacter pylori- and non-steroidal anti-inflammatory drug-induced inflammatory changes. Frank ulcerations are present in 20% of all long term users, with an even distribution between stomach and duodenum. Multiple ulceration in the antrum and prepyloric area are typical, but non-steroidal anti-inflammatory drug ulcer may be indistinguishable from Helicobacter pylori ulcers and gastric cancers. Thus, even in the context of non-steroidal anti-inflammatory drug exposure, the possibility of malignancy must be ruled out by serial biopsies until complete healing.