Endoscopic Comparison of Alcohol, Non-Steroidal Anti-inflammatory Drugs (NSAIDs) and Low Dose Aspirin (LDA) Induced Upper Gastrointestinal Damage in a Cohort of Adult Sri Lankan, Presented to a Tertiary Referral Center

Abstract

Purpose: Alcohol, NSAIDs and LDA are ubiquitous substances used worldwide and are claimed to cause upper gastrointestinal damage but no comparative studies are available to elucidate the magnitude of such endoscopic damage on literature search which prompted us to design the following study, although much is written on peptic ulcer disease due to NSAIDs and to a lesser extent on LDA. Methods: Case notes of 1492 symptomatic patients who underwent upper gastrointestinal endoscopy from 1/3/2002 to 1/3/2004 in principal author's unit at Sri Jayewardenepura General Hospital, Kotte, Sri Lanka were retrospectively analyzed. Those who had consumed alcohol and those who were either on NSAIDs or LDA were selected for the study. Results: Prior to endoscopy 220 had been on significant quantities of alcohol for at least 6 months, 95 had been on NSAIDs for at least one month, and 42 had been on LDA for at least 1 month. Alcoholics presented with hematemesis, melena or both in 43%, 33% and 20% respectively. 33% had proven alcoholic liver disease. Endoscopy showed esophageal varices, portal hypertensive gastropathy, Antral gastritis and duodenitits, gastric erosions, esophagitis, pangastritis, peptic ulcer disease (PUD) in 5%, 36%, 33%, 29%, 27%, 17% and 12% respectively. CLO test had been done in 64. It was positive in 18. NSAID users also presented with dyspepsia, abdominal pain, upper GI bleeding, anemia and reflux symptoms in 25%, 18%, 17%, 15% and 9% respectively. Aspirin users had been above 40%, 17%, 36%, 11% and 9% respectively. Endoscopy revealed severe antral gastritis and duodenitis, gastric erosions, esophagitis, PUD and pangastritis in 55%, 46%, 32%, 18%, 8% respectively in NSAID users while same was observed in 68%, 36%, 36%, 30% and 15% respectively in aspirin users. Overlapping pathologies were noted. Conclusion: This study shows that all these substances, alcohol, NSAIDs and LDA are almost equipotent in causing upper GI damage. Those due to NSAIDs and LDA are reversible but pathologies such as varices, portal hypertensive gastropathy caused by alcohol pose a potentially irreversible contribution in the long term morbidity and mortality threats even after cessation of alcohol consumption. In this sense alcohol remains potentially the most feared agent of long term GI damage compared to the other two.