Nsaid Gastropathy

From Anvita Health Wiki

Contents 1 Etiology 2 Epidemiology 3 Pathology 4 Clinical-manifestations 5 Management 6 More General Terms 7 Additional Terms 8 References

Etiology

• non-steroidal anti inflammatory agents ( NSAIDs)
• risk factors

• history of peptic ulcer
• high-dose NSAID use
• simultaneous use of multiple NSAIDs
• age > 60 years
• concomitant use of glucocorticoids
• anticoagulation
• tobacco use
• alcohol use
• protein malnutrition
• female sex
• concomitant cardiac disease
• concomitant H pylori infection*

• * controversial

Epidemiology

• 5-10% of duodenal ulcers
• 20-40% as gastric ulcers

Pathology

• occult blood loss & iron deficiency anemia

Clinical-manifestations

• dyspepsia

• NOT predictive of NSAID gastropathy
• many patients have no antecedent dyspepsia

• peptic ulcer disease (20%)*
• acute upper GI hemorrhage or perforation (1-2%)

• * 20% of patients taking NSAIDs long-term will have endoscopic evidence of gastric or duodenal ulceration

Management

• proton-pump inhibitors

• prevention of peptic ulcers in patients using NSAIDs [3]
• can heal gastric (& probably duodenal) ulcers even while NSAID therapy is continued [2,4]
• more effective than H2-receptor antagonists

• H2-receptor antagonists

• may decrease incidence of duodenal ulcers
• not effective for prevention of gastric ulcers*

• misoprostol

• 200-400 mg PO QID
• can heal as well as prevent ulcers in most patients taking NSAIDs
• ONLY agent with proven benefit in patients with rheumatoid arthritis

• treat concurrent H. pylori infection
• sucralfate of NO benefit [2]
• stopping NSAID may be indicated
• a COX-2 inhibitor may be useful

• * one study found famotidine effective in prevention of both duodenal & gastric ulcers in patients on long-term NSAID therapy

More General Terms

• peptic ulcer disease (PUD)
• gastritis

Additional Terms

• cyclooxygenase-2 (COX-2) specific inhibitor
• diabetes mellitus
• dyspepsia (indigestion)
• Helicobacter pylori
• misoprostol (Cytotec)
• non-steroidal anti-inflammatory agent (NSAID)
• proton pump inhibitor

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
2. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
3. Scheiman JM et al, Prevention of ulcers by esomeprazole in at-risk patients using non-selective NSAIDs and COX-2 inhibitors Am J Gastroenterol 2006; 1-1:701 PMID: [1]
4. Luo J-C et al. Randomised clinical trial: Rabeprazole plus aspirin is not inferior to rabeprazole plus clopidogrel for the healing of aspirin-related peptic ulcer. Aliment Pharmacol Ther 2011 Sep; 34:519 PMID: [2]

NSAID gastropathy