History Of Non-steroidal Anti-inflammatory Drugs Research Articles

Iron Deficiency Anemia: The Contribution of Upper Digestive Endoscopy in Etiological Investigation

Iron-deficiency anemia is very common among patients in gastroenterology. The digestive system plays a key role in the pathophysiology of iron-deficiency. Indeed, digestive causes are one the most fequent etiology. This is why endoscopic evaluation is part of the etiological assessment of iron-deficiency anemia. The aim of this study is to investigate the usefulness of esophagogastroduodenoscopy (EGD) and histopathology in the etiological diagnosis of iron-deficiency anemias. Materials and Methods: This is a monocentric study conducted from January 2019 to December 2023. All patients with iron-deficiency anemia who underwent EGD were included. Various data were recorded, including patients' epidemiological information, laboratory findings, and results from endoscopic examinations. Results: Out of 2960 EGD, 576 (19,5%) were included in the study. The mean age of the patients was 49.81 years, ranging from 18 to 83 years. The male-to-female sex ratio was 0.67. It is notable that 47.5% of the patients had various medical histories: inflammatory bowel disease (IBD) in 19.13% of cases, history of non-steroidal anti-inflammatory drug (NSAID) use in 12.17%, coeliac disease in 6.13%, cirrhosis with portal hypertension in 8.70%. All patients underwent EGD. An abnormality was found in 63.4% of cases, including: Esophageal lesions: gastroesophageal varices in 13.3% of cases, erosive esophagitis in 7.5%, esophageal tumor in 0.6% of cases. Gastric lesions: erosive gastritis in 35% of cases, ulcerative gastritis in 22%, erythematous gastritis in 17%, gastric tumor in 15% of cases, supra-centimetric hyperplastic polyps in 5% of cases. Bulboduodenal lesions: erosive bulboduodenitis in 25% of cases, ulcerative bulboduodenitis in 18%, duodenal fold rarefaction in 16%, angiodysplasia in 3.5%. Gastric and duodenal biopsies were systematically performed. Duodenal biopsies showed a celiac disease aspect in 7.6% of cases, and nonspecific duodenitis in 4.6% of cases. Gastric biopsies revealed gastritis with Helicobacter pylori (Hp) in 57.6% of cases. Thus, the diagnostic yield of EGD was 47.33%. Conclusion: Iron deficiency anemia are common medical conditions in daily clinical practice. The multiple etiologies of iron deficiency anemia and the nonspecificity of symptoms make diagnosis difficult. Gastrointestinal lesions are frequently observed in patients with iron deficiency anemia. Digestive endoscopy has a great value in the etiological investigation of this pathology. Gastroscopy allows for the etiological diagnosis for many patients that’s why it is systematically recommended do it.

Risk factors and outcomes of upper gastrointestinal bleeding in hospitalized patients in a tertiary care hospital.

To determine different aetiologies and outcomes of upper gastrointestinal bleeding in hospitalised patients. The retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from December 2019 to April 2021 related to adult patients of either gender with nongastrointestinal illnesses who developed bleeding at least 24 hours after admission. Data was reviewed for clinical characteristics, cause of bleeding and clinical outcome. Data was analysed using SPSS 23. Among 47,337 hospitalised patients, upper gastrointestinal bleeding was identified in 147(0.3%); 98 (66.7%) males and 49 (33.3%) females. The overall mean age was 62.73±14.81 years (range 20-95 years). Of the total, 125(85%) presented with overt bleeding and 22(15%) with a drop in haemoglobin level. There were 34(23%) patients on aspirin, 36(24%) on dual anti-platelets, 41(28%) on therapeutic anticoagulation, and 81(55%) on prophylactic anticoagulation. There were 7(5%) patients having a history of non-steroidal anti-inflammatory drugs (NSAIDs), and 12(8%) were on steroids. In terms of associated medical conditions, pneumonia, stroke, and acute coronary syndrome were commonly seen with frequency of 29.9%, 8.1% and 7.4% respectively. Overall, 36(24.4%) patients underwent endoscopy, 8(5.4%) had therapeutic measures to control bleeding, 14(9.5%) had bleeding for >48 hours, 89(60.5%) were stepped up to special care. Mortality was seen in 36(24.5%) cases. Hospital acquired gastrointestinal bleeding was found to be uncommon, and there were several risk factors for such bleeding events.

An evaluation of the relationship between the occurrence of chronic kidney disease and the use of NSAIDs

Background: Non-steroidal Anti-Inflammatory Drugs (NSAIDs) are painkillers that Indonesians widely use. Many people use it because it is easy to get and low price. Although, the public does not pay attention to safety in its use. This study aims to determine the relationship and the level of causality between the use of NSAIDs and chronic kidney disease (CKD) events. Methods: An observational case-control with retrospective retrieval was adopted, and the risk factors between the use of NSAIDs and CKD events were analyzed. Meanwhile, the study was conducted in Makassar city hospital with consecutive sampling from January 2017 until January 2018. Results: The results showed that 118 patients from a total of 350 used NSAIDs, while 35 of the 175 with CKD had a history of NSAIDs. Furthermore, the data on the use of NSAIDs in these patients was 40% meloxicam and 10% mefenamic acid, and the result of the Chi-square analysis showed a p-value <0.001 and an OR of 0.277. Additionally, the possible incidence of CKD in men and women is 48.55% and 70.72%, respectively, with a history of using NSAIDs for over 3 months. It was further shown that 2 of 118 patients had side effects from CKD due to the long-term use of NSAIDs. Conclusion: Conclusively, there is no relationship between CKD incidence and the use of NSAIDs in the community. However, some CKD side effects are related to NSAIDs, which implies that NSAIDs do not result in CKD.

Gastric Perforation Associated with Candidiasis and NSAIDS

Invasive candidiasis is an important health-care-associated fungal infection. Candida is often described as an opportunistic pathogen. It is commensal flora in the gastrointestinal tract. Invasive candidiasis can happen usually because of a consequence of increased or abnormal colonization together with a local or generalized defect in host defenses. Candidiasis can occur in patients with HIV, therapy with a broad-spectrum antibiotic, transplant organ, and immunocompromised. Most cases of gastric perforation occur as complications of Peptic Ulcer Disease (PUD), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and gastric neoplasms, but candidiasis as a cause of gastric perforation is very rare. This study aims to reveal the correlation between gastric perforation with candidiasis and NSAIDs. It was reported that a 57-year-old East Java Indonesian female presented with severe epigastric pain, generalized peritonitis, fever, nausea also vomiting and had a history of NSAIDs used for five years. The patient was taken to the general surgery of Dr. Sutomo Surabaya Hospital and performed exploratory laparotomy. A gastric perforation was discovered in the antrum. Microbiology culture examination from biopsy gastric tissue revealed an intense fungal growth from sabouraudagar medium and there is no other microorganism that grew in aerobic culture. Candida albicans was identified by VITEK® 2 COMPACT. Histopathological examination from biopsy gastric tissue was performed by Olympus CX-21 microscope, showed invasive Candida albicans consisting of numerous fungal yeasts and pseudohyphae invading and destroying the gastric wall. The patient was subsequently treated with fluconazole anti-fungal and discharge home after nine days postoperative period in good condition. From this result, we suggest using an antifungal treatment for patients who use NSAIDs for long periods to prevent candidiasis.

P324 Deep enteroscopy after balloon dilatation for differential diagnosis of small bowel stricture

Abstract Background Use of non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin may result in gastrointestinal complications including ulceration, bleeding, and stricture. Chronic fibrosis and chronic ulcerations form bowel stricture which is the most severe stage of NSAIDs induced enteropathy. Capsule endoscopy and balloon enteroscopy may provide detailed information of small bowel mucosal lesions such as longitudinal ulceration suggesting Crohn’s disease. However, more distal or proximal evaluation above stricture is impossible due to severe stricture. Nowadays, balloon dilatation through the enterosope is available and can dilate stricture site by expanding force. This technique allows enteroscope to pass of stricture site and provides accurate evaluation of more proximal or distal small bowel above the stricture. We report our experience of small bowel evaluation after balloon dilatation. Methods Nine patients with small bowel stricture and history of NSAIDs between 2012 February and 2019 October were analysed. All patients with small bowel stricture had symptoms including abdominal pain, abdominal fullness, or vomiting and enteroscope could not pass the stricture site. Balloon dilatations were performed with through the scope balloon from 8 mm to 15 mm diameter in these patients. After adequate dilation, enteroscope passage could pass the stricture site. Detailed mucosal evaluation of more proximal or distal small bowel above the stricture was performed. Results Successful and adequate balloon dilation of small bowel stricture was achieved in 9 of 9 patients. Additional deep and longitudinal ulceration suggesting Crohn’s disease was found after successful passage of enteroscope in 3 of 9 patients. In 6 of 9 patients, additional chronic shallow ulcerative lesions without deep and longitudinal ulceration was found after eneteroscope passage. Deep enteroscopy after balloon dilatation provided important diagnostic clue and treatment strategy in 3 of 9 patients. Conclusion Deep small bowel evaluation above the stricture after balloon dilatation may provide additional and detailed information for differential diagnosis of small bowel stricture.

Prepyloric Diverticulum in a Nigerian: Case Report of a Rare Finding

Diverticulae are uncommonly encountered in the stomach. They can be congenital or acquired- the latter variety being the less frequent of the two. This article details one such rare case from Lagos, Nigeria and discusses certain aspects of its clinical and endoscopic presentation. We present a 59-year old with a background history of non-steroidal anti-inflammatory drugs abuse presented with hematemesis and melena and was in hemorrhagic shock. After stabilization, the gastroscopy findings were of a gastric diverticulum (GD) in the anterior prepyloric wall. There was a Forrest IIb ulcer in the GD’s wall with surrounding erythema and edema. The patient was successfully managed medically and conservatively and with good long term results.

NSAID Aids in Diagnosis of Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract and may present either asymptomatically or with nonspecific GI symptoms. The subepithelial nature of these tumors and wide range of localization within the GI tract make the diagnosis of GIST difficult. A 53-year-old gentleman, with a history of non-steroidal anti-inflammatory drugs (NSAID) use for chronic pain, presented with lightheadedness. A week prior, he underwent tooth extraction secondary to severe periodontal disease. Patient noted increased NSAID use since surgery. Further, he also reported melanotic stool. Labs showed hemoglobin of 5.8 G/DL. The esophagogastroduodenoscopy found a large 3 cm duodenal ulcer with visible vessel. Biopsies were taken at the ulcer edge and due to the friability of the tissue, bleeding ensued. The brisk bleeding lead to difficulty localizing the site of bleeding, thus a hemo-clip was deployed near the ulcer site as a fiduciary marker. Subsequently, interventional radiology performed celiac / gastric duodenal artery (GDA) and superior mesenteric artery arteriogram with successful GDA embolization and cessation of bleeding. Computerized tomography of the abdomen with contrast, revealed a 5.0 x 5.5 cm mass adjacent to the pancreatic head/peri-ampullary. A duodenal GIST was suspected from biopsies, and the patient subsequently underwent a pylorus-sparing Whipple procedure with biopsies confirming GIST. GISTs occur in 15 per 1 million people. GI bleeds are encountered due to tumor erosion into the mucosal surface of the GI tract. GISTs are localized to the stomach in about 60-70% of cases with localization to the duodenum in only about 3-5% of cases. Due to the subepithelial localization that is typical for these tumors and the nonspecific nature of symptoms, diagnosis can be difficult with metastatic disease encountered upon initial diagnosis in approximately 50% of cases. Surgical resection is the primary treatment of choice for localized GISTs. Our patient's NSAID use led to a GI bleed that unmasked a duodenal ulcer which, subsequently, aided in the diagnosis of a GIST early enough for curative resection.2990_A Figure 1. Endoscopic view of ulcer base within duodenum.2990_B Figure 2. Lateral View CT imaging showing duodenal gastrointestinal stromal tumor (black arrow) and hemoclip (white arrow).2990_C Figure 3. Coronal View CT imaging showing duodenal gastrointestinal stromal tumor (black arrow) and hemoclip (white arrow).

Establishing a Safe Administration of ASA in Cardiovascular Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity with Skin and/or Respiratory Involvement

Background: A history of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity with cross-intolerance to several drugs is common in some patients with coronary artery disease. We present a series of patients with acute coronary syndrome undergoing ASA desensitization prior to a possible stent to evaluate the short- and long-term efficacy and safety. The aim was to evaluate the outcomes of an ASA desensitization protocol developed by our center based on the guidelines proposed by the EAACI drug allergy expert recommendations. Methods: We developed a desensitization protocol that was based on both the patient characteristics and onset of reaction after NSAIDs, including premedication with a leukotriene antagonist and the H1-antagonist antihistamine. The clinical entities were NSAID-induced urticaria and/or angioedema in the absence of chronic spontaneous urticaria (NIUA) and NSAID-exacerbated respiratory disease (NERD). Results: A total of 23 patients were challenged or desensitized with ASA: 19 NIUA and 4 NERD. All patients tolerated the protocol at the different times of 30, 45, 90, and 120 min. The dosages of oral ASA that were given included 10, 21, 41, 81, and 162 mg (cumulative dose 315 mg). One patient reacted during the procedure and 1 during follow-up. Symptoms were limited to the skin without manifestations in other organs. All patients tolerated the required dose of ASA within 30–120 min. Those requiring urgent catheterization were desensitized within 90 min. Conclusions: Our protocol addresses challenge or desensitization with the contribution of a specialist allergist. It provides an effective, dynamic, safe, and short administration of 81 mg or higher of ASA in patients with a history of NSAID hypersensitivity with skin involvement.

Evaluating clinical, dietary, and psychological risk factors for relapse of ulcerative colitis in clinical, endoscopic, and histological remission.

The literature on possible factors that could trigger a relapse in patients with ulcerative colitis (UC) in clinical, endoscopic, and histological remission on long-term follow up is scarce. To determine the relapse rate in patients with UC in clinical, endoscopic, and histological remission and identify factors that may influence the risk of relapse. Patients with UC in clinical, endoscopic, and histological remission were enrolled between January and July 2010 and followed up for 1year to determine the effect of clinical, dietary, and psychological factors on relapse. Information regarding factors that may affect relapse such as infection, antibiotic, or non-steroidal anti-inflammatory drugs (NSAIDs) use and any other factor that the patient felt important and compliance with medications was obtained. Ninety-seven patients (59 males, mean age 39±11.9years) were followed up for a mean duration of 9±2.3months. Eighteen (18.6%) relapsed with the median time to relapse being 3.5months. On univariate analysis, more relapsers had significantly higher NSAIDs use within 15days of relapse, respiratory tract infection within 4weeks, use of steroids more than once in past, higher consumption of calcium, riboflavin, and vitamin A, and lower consumption of sugars. On multivariate analysis, NSAIDs use (HR [95% CI]: 6.41 [1.88-21.9]) and intake of vitamin A (HR [95% CI]: 1.008 [1.000-1.016]) were statistically significant predictors of relapse. With a relapse rate of 18.6% over a follow up of 9months in patients with UC in clinical, endoscopic, and histological remission, independent predictors of relapse were history of NSAIDs use within 15days of relapse and higher intake of vitamin A.

Effect of scheduled second-look endoscopy on peptic ulcer bleeding: a prospective randomized multicenter trial

This study aimed to investigate the effectiveness of scheduled second-look endoscopy (EGD) with endoscopic hemostasis on peptic ulcer rebleeding and to identify the risk factors related to the need for second-look EGD. We prospectively randomized patients who had endoscopically confirmed bleeding peptic ulcer with stigmata of active bleeding, visible vessel, or adherent clot into 2 groups between August 2010 and January 2013. Hemoclip application or thermal coagulation and/or epinephrine injection were allowed for initial endoscopic therapy. The same dosage of proton pump inhibitor was injected intravenously. The study group received scheduled second-look EGD 24 to 36 hours after the initial hemostasis, and further therapy was applied if endoscopic stigmata persisted, as above. Those patients who developed rebleeding underwent operation or radiologic intervention despite the additional endoscopic therapy. Outcome measures included rebleeding, amount of transfusion, duration of hospitalization, and mortality. After initial endoscopic hemostasis, 319 eligible patients were randomized into 2 groups. Sixteen(10.1%) and 9 (5.6%) patients developed rebleeding (P= .132), respectively. There was also no difference in surgical intervention (0, 0% vs 1, .6%, P >.999) or radiologic intervention (3, 1.9% vs 2, 1.2%, P= .683), median duration of hospitalization (6.0 vs 5.0 days, P= .151), amount of transfusion (2.4±1.7 vs 2.2 ± 1.6 units, P= .276), and mortality (2, 1.3% vs 2, 1.2%, P > .999) between the 2 groups. Multivariate analysis showed that grades 3 to 4 of endoscopists' estimation to success of initial hemostasis, history of nonsteroidal anti-inflammatory drug (NSAID) use, and larger amounts of blood transfusions (≥4units of red blood cells) were the independent risk factors of rebleeding. A single EGD with endoscopic hemostasis is not inferior to scheduled second-look endoscopyin terms of reduction in rebleeding rate of peptic ulcer bleeding. Repeat endoscopy would be helpful in the patients with unsatisfactory initial endoscopic hemostasis, use of NSAIDs, and larger amounts of transfused blood. (Clinical trial registration number: KCT0000565; 4-2010-0348.).

Nonsteroidal anti-inflammatory drugs, statins, and pancreatic cancer risk: a population-based case-control study.

Studies suggest that aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and statins may reduce risk of some cancers. However, findings have been conflicting as to whether these agents reduce the risk of pancreatic cancer. We used data from the Queensland Pancreatic Cancer Study, a population-based case-control study. In total, 704 cases and 711 age- and sex-matched controls were recruited. Participants completed an interview in which they were asked about history of NSAID and statin use. We included 522 cases and 653 controls who had completed the medication section of the interview in this analysis. Unconditional multivariable logistic regression was used to estimate associations between medication use and pancreatic cancer. We found no consistent evidence of an association between use of NSAIDs or statins and risk of pancreatic cancer. There was some suggestion of a protective effect in infrequent users of selective COX-2 inhibitors, but no association in more frequent users. We did not find evidence of protective effects in analyses stratified by sex, smoking status, time between diagnosis and interview, or presence/absence of metastases. Overall, our results do support the hypothesis that use of NSAIDs or statins may reduce the odds of developing pancreatic cancer.

Retention of Capsule Endoscopy at the Site of NSAIDs-induced Intestinal Ulcer ―Lessons to Learn―

A 77-year-old man with a history of non-steroidal anti-inflammatory drugs (NSAID) use was admitted to our hospital due to anemia and hypoalbuminemia. Radioisotope scintigraphy indicated protein loss from the small intestine. The patient underwent capsule endoscopy, which was later found to be retained in the ileum. Double-balloon endoscopy showed multiple strictures with ulcers in the small intestine. The capsule was found in proximal to one of the stenosis, and was removed by doubleballoon enteroscopy. Based on endoscopic findings, NSAID-induced enteritis was diagnosed. Although anemia and hypoalbuminemia improved after discontinuing NSAID, the patient developed ileus and underwent partial resection of the ileum. Multiple diaphragm-like strictures were present in the resected intestine. The current case highlights the importance of screening for intestinal strictures when NSAID ulcer is suspected. ACTA MEDICA NAGASAKIENSIA 58: 135−138, 2014

Sloughing esophageal mucosa

A 52-year-old man presented with 3-week history of passing bright red blood per rectum. His medical history was significant for hypertension, gastroesophageal reflux disease and iron-deficiency anemia. He had a similar episode 3 years ago for which colonoscopy was done and showed hyperplastic polyp in transverse colon and non-bleeding internal hemorrhoids. He denied any history of nausea, vomiting, abdominal pain, food intolerance or change in appetite or weight. He had no history of nonsteroidal anti-inflammatory drug (NSAID) or bisphosphonate use, chemical irritants, hot beverages, autoimmune skin diseases and celiac disease. His social history was significant for smoking (20 pack-year history) and occasional alcohol use. He denied illicit drug abuse. His home medications were lisinopril and hydrochlorothiazide. On examination, vital signs were within normal limits except for sinus tachycardia (HR 105/min). There was significant pallor and 2/6 ejection systolic murmur was heard all over the precordium. Rectal examination was unremarkable and the fecal occult blood was negative upon …

Cryptogenic multifocal ulcerous stenosing enteritis – a case report

<h3>Background</h3> Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing episodes of small intestinal obstruction resulting from multiple small intestinal strictures and shallow ulcers. The aetiology of CMUSE has not yet been clarified, and pathogenesis is still poorly understood. Some authors suggest that CMUSE may be related to a particular form of vasculitis. <h3>Case report</h3> We present a case of a 33-year-old woman, who did not have a history of non-steroidal anti-inflammatory drug (NSAID) use, with multiple episodes of small intestinal obstruction. She underwent small bowel resection three times. The small bowel resection specimens macroscopically revealed multiple strictures and shallow ulcers. Microscopically, sections of both the ulcers and strictures showed broad based superficial ulceration of the mucosa and submucosa. The submucosa was thickened by fibrosis but the muscularis propria was nearly normal. Prominent lymphoid aggregates and granulomas were not identified. <h3>Conclusion</h3> The case exhibited features suggestive of CMUSE. CMUSE remains in part a diagnosis of exclusion, with Crohn disease, drug-induced small bowel ulceration, gluten sensitive enteropathy, peptic ulceration, lymphoma, infection, trauma, and ischaemia related to vasculopathy being the principal differential diagnostic considerations.

Atherosclerosis and acetylsalicylic acid are independent risk factors for hemorrhage in patients with gastric or duodenal ulcer

Risk factors for hemorrhage due to gastric and/or duodenal ulcer in patients diagnosed by upper gastrointestinal (GI) endoscopy were investigated in the present study. Medical records of 350 patients (226 males, 124 females) diagnosed as duodenal or gastric ulcers by GI endoscopy in the gastroenterology clinic were scanned retrospectively. Upper GI hemorrhage was detected in 92 patients by upper endoscopic examination. The medical history of non-steroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid (ASA) usage and the presence of coronary artery disease (CAD) were investigated in all patients with or without hemorrhage. Results were evaluated by Chi-square test and logistic regression analysis. The mean age of the patients was 50.4 ± 15.7 years (range: 25 to 82 years). Hemorrhage due to gastric or duodenal ulcer was identified in 92 patients (26%). Mean age was 64.6 ± 11.4 years in patients with hemorrhage and 45.7 ± 13.9 years in patients without hemorrhage. ASA usage was more common than NSAID in patients with ulcer hemorrhage (NSAID usage n=35 (40%); ASA usage n=51 (60%); p=0.035). Hemorrhage was reported in 20% of the females and in 28% of the males who have ulcer (p=0.055). Risk factors for hemorrhage were CAD (OR:24.75, 95% CI=1.6-96.7, p=0.001), ASA usage (OR:9.76, 95% CI=2.1-37.5, p=0.021), NSAID usage (OR: 4.72, 95%CI=1.1-16.5, p=0.032), age (OR: 11.59, 95% CI= 2.7-12.1, p=0.001), and male gender (OR: 2.56, 95% CI= 0.8, 9.6, p=0.052). Advanced age, atherosclerosis, male gender and NSAID administration (particularly aspirin) are the major risk factors of upper GI hemorrhage in patients with gastric and/or duodenal ulcer.

NSAID-induced deleterious effects on the proximal and mid small bowel in seronegative spondyloarthropathy patients

To investigate the small bowel of seronegative spondyloarthropathy (SpA) patients in order to ascertain the presence of mucosal lesions. Between January 2008 and June 2010, 54 consecutive patients were enrolled and submitted to a video capsule endoscopy (VCE) examination. History and demographic data were taken, as well as the history of non-steroidal anti-inflammatory drug (NSAID) consumption. After reading each VCE recording, a capsule endoscopy scoring index for small bowel mucosal inflammatory change (Lewis score) was calculated. Statistical analysis of the data was performed. The Lewis score for the whole cohort was 397.73. It was higher in the NSAID consumption subgroup (P = 0.036). The difference in Lewis score between NSAID users and non-users was reproduced for the first and second proximal tertiles of the small bowel, but not for its distal third (P values of 0.036, 0.001 and 0.18, respectively). There was no statistical significant difference between the groups with regard to age or sex of the patients. The intestinal inflammatory involvement of SpA patients is more prominent in NSAID users for the proximal/mid small bowel, but not for its distal part.

Aortoenteric fistula in a patient with right common iliac aortic aneurysm

A 63-year-old man with a history of hypertension had undergone ruptured abdominal aortic aneurysm repair. He presented to the emergency room with a 1-day history of passing bloody stools. He had mild abdominal distention and did not have abdominal pain, nausea or a history of non-steroidal anti-inflammatory drug (NSAID) or steroid use. The physical examination revealed mildly pale conjunctiva, hyperactive bowel sound and no abdominal tenderness. Esophagogastroduodenoscopy and colonoscopy did not reveal the site of active bleeding. Abdominal computed tomography (CT) (Figure 1A and B) …

Upper gastrointestinal problems in inhalational ketamine abusers

To study the association between upper gastrointestinal (GI) problems and inhalational ketamine abuse. This is a retrospective study of 64 ketamine abusers treated from 2001 to 2008. Variables studied included clinical presentations, findings of upper GI endoscopy, abstinence from ketamine and relief of epigastric pain. The following patients with (i) a previous history of upper GI problem; (ii) a history of non-steroidal anti-inflammatory drug (NSAID), aspirin or other substance abuse; and (iii) a known history of Helicobacter pylori (H. pylori) infection were excluded. The study group thus consisted of 37 ketamine abusers, of whom 28 had upper GI symptoms. Overall 14 of these patients had an upper endoscopy performed. The endoscopic diagnoses were: 12 (85.7%) with gastritis, one (7.1%) with gastroduodenitis, and one (7.1%) normal finding. Test for H. pylori, infection was negative. Abstinence from ketamine was found to be associated significantly with relief of symptoms (P= 0.027). Logistic regression showed the odds ratio of symptomatic relief for abstinence versus continued use of ketamine is 12.5 (95% CI[1.20, 130.6], P= 0.035). In patients whom an upper GI endoscopy was performed, H. pylori negative gastritis was the commonest histopathological finding (78.6%). Despite the use of medications, symptoms are commonly not relieved and that is associated with the continued abuse of ketamine. Ketamine abusers frequently presented with upper GI symptoms, the commonest of which is epigastric pain (73% of abusers). Abstinence from ketamine abuse can lead to the relief of symptoms, which is an important message for ketamine abusers.

Risk factors and therapeutic response in Chinese patients with peptic ulcer disease

To assess the risk factors and the efficacy of medications of patients with gastric and duodenal ulcers among Chinese patients in Taiwan. Patients with peptic ulcers, diagnosed by upper endoscopy, were retrospectively collected between January 2008 and December 2008. The differences were compared. Among all 448 cases, 254 (56.6%) and 194 (43.4%) patients had gastric ulcers and duodenal ulcers respectively. Patients with gastric ulcers were younger than those with duodenal ulcers. Although more men existed, there was a female predominance in middle-aged cases. Patients with duodenal ulcers had a higher rate of Helicobacter pylori (H. pylori) infection (62.4% vs 43.3%, P = 0.001), and those with gastric ulcers owned a significantly higher amount of aspirin and nonsteroidal anti-inflammatory drug (NSAID) use (7.5% vs 1.5%, 6.7% vs 2.1%, P = 0.001). Tobacco smoking and alcohol drinking had no different impact between these two groups. Proton-pump inhibitors and H2-receptor antagonists (H2RA) were effective, but significantly less so in cases with duodenal ulcers receiving H2RAs, or in those with H. pylori infection and a history of NSAID use. Patients with gastric ulcers had lower H. pylori infection but more aspirin or NSAID use. Antisecretory therapy was ineffective in gastric ulcers underwent H2RA treatment, and cases combined H. pylori infection and NSAID use.

NSAIDs applied to the skin: a very topical subject

Healers have used plants containing salicylates to alleviate pain, infl ammation and fever for millennia. The clinical and commercial success of acetylsalicylic acid (aspirin) prompted the development of the plethora of non-steroidal anti-infl ammatory drugs (NSAIDs) available today. Although commonplace, there is a danger that therapeutic familiarity can breed toxicological contempt. NSAIDs can cause serious, even life-threatening gastrointestinal, cardiovascular and other side effects. The risk of adverse events prompted the search for better-tolerated alternatives, including topical preparations. Despite some initial scepticism, a growing body of clinical and pharmacological evidence suggests that topical NSAIDs offer an effective and well-tolerated treatment for several conditions that produce chronic or acute pain. This article briefl y describes the history of NSAIDs and how they work, before focusing on the use of topical NSAIDs as a therapeutic option.