The ulcerogenic potential of glucocorticoids and possible prophylactic measures

Corticosteroids and ulcers: is there an association?

The literature presented supports a small but highly probable association between corticosteroids and ulcers. The following characteristics appear to be exhibited by patients who are at high risk for developing corticosteroid-induced ulcers: corticosteroids coadministered with NSAIDs, a total dosage greater than 1000 mg of prednisone equivalent, a duration of therapy longer than 30 days, and a history of PUD. Further prospective research examining the association of corticosteroids and PUD in conjunction with other contributing factors is needed. The role of prophylactic therapy to prevent corticosteroid-induced ulcers is not well established. Even though a small study in liver transplant recipients, who are already at increased risk for GI ulceration, has suggested beneficial effects with prophylactic regimens, generalization of these results to all corticosteroid-treated patients would be inappropriate. Large prospective trials to determine the most efficacious prophylactic regimen (e.g., histamine2-receptor antagonists, proton pump inhibitors, cytoprotective agents [misoprostol]) for corticosteroid-induced ulcerations are not currently available. We suggest that most prophylaxis currently performed is unnecessary. In high-risk patients, however, prophylaxis appears to be prudent until further information is available.

Biological activity of some Schiff bases and their metal complexes

Schiff bases derived from salicylaldehyde and 2-substituted aniline and their metal chelates with Cu(II), Ni(II), and Co(II) ions were synthesized and screened for the antiinflammatory and antiulcer activity. The compound salicylidene-anthranilic acid (SAA) was found to possess the antiinflammatory and antiulcer activity. The copper complexes showed an increased antiulcer activity. The SAA is perhaps acting by influencing prostaglandin biosynthesis.

Adrenocorticosteroid therapy and gastroduodenal lesions

Gastroduodenoscopy was performed in 25 patients with various disorders, such as liver cirrhosis, nephrotic syndrome, and ulcerative colitis, to assess the effects of corticosteroids on the stomach and duodenum. The main criterion for entry into the trial was the absence of open ulcer, healed ulcer, erosion, or bleeding from the stomach or duodenum on pretreatment endoscopy performed within 48 hours before administration of corticosteroids. Endoscopy repeated at 2 to 4 weeks disclosed gastroduodenal lesions in 11 cases (44%)and no lesion in 14 cases (56%). The gastroduodenal lesions observed in 11 cases are as follows: one gastric ulcer (4.0%), six gastric erosions (24.0%), two gastroduodenal erosions (8.0%), and two duodenal erosions (8.0%). A lack of correlation between the patients' subjective complaints and endoscopic findings indicates the unreliability of patients' complaints and the importance of endoscopy in assessing gastroduodenal lesions. There were no differences in the total and average daily doses of corticosteroid between a group with gastric and/ or duodenal lesions and a group without such lesions. Corticosteroids may produce gastroduodenal lesions, regardless of the dose.

The effect of food and tablet formulation on plasma prednisolone levels following administration of enteric-coated tablets

1 Plasma prednisolone levels have been compared following the administration of enteric-coated prednisolone to fasted and non-fasted subjects. The effect on plasma levels of altering the formulation of the enteric-coating has also been studied. 2 The presence of food in the stomach at the time of administration does not affect the absorption of enteric-coated prednisolone tablets. 3 There was considerable inter-subject variation in plasma prednisolone levels after administration of shellac based enteric-coated tablets. However, plasma levels were more consistent when a preparation whose formulation was based upon cellulose acetate phthalate (CAP) was given. 4 It is concluded that the pattern of absorption and plasma prednisolone levels depend on the formulation of the enteric coating. The bioavailability of the CAP based preparation is similar to that of plain prednisolone.

Drug-induced gastrointestinal disease

The gastrointestinal tract is a common target for adverse drug reactions. The resultant changes are often nonspecific (e.g., mucosal ulceration, intestinal infarction, motility disturbance) and in many cases no radiographically detectable lesion may occur. A comprehensive review of the reported drug-induced disorders of the digestive organs is herein presented and their radiographic manifestations are described.