Mechanisms of NSAID-induced gastrointestinal mucosal injury: a basis for preventing ulceration and symptoms from these agents

Gastritis in patients on non-steroidal anti-inflammatory drugs

This study investigated the spectrum of gastric mucosal pathology, including the prevalence of reactive gastritis in patients on non-steroidal anti-inflammatory drugs (NSAIDs). The histological findings were correlated with upper gastrointestinal symptom status and endoscopic findings and were also compared with the histological appearances of the gastric mucosa in a corresponding age-matched control group of 75 patients not receiving NSAIDs or any other drug therapy. Reactive gastritis of the gastric antrum was more common in the NSAID group and was observed in 34 patients (45.3%), as an isolated phenomenon in 24 patients (32%) and with evidence of coexistent chronic gastritis in 10 patients (13.3%). In the control group reactive gastritis of the antrum was seen in 10 patients (13.3%), as an isolated finding in eight cases (10.7%) and with accompanying chronic gastritis in two cases. Chronic antral gastritis of usual type was observed in 36 patients on NSAIDs (48%) and Helicobacter-like organisms were identified histologically in 18 of these (50% carriage rate). These organisms were not seen in any of the patients in whom the picture of reactive gastritis was present. In the control group chronic antral gastritis was seen in 51 patients (68%) with organisms in 34 (66.6% carriage rate). No correlation was found between the presence or absence of upper gastrointestinal symptoms, endoscopic findings and the histological appearances of the gastric mucosa. We conclude that NSAIDs are an independent cause of reactive gastritis in the antrum and do not appear to alter gastric mucosal colonization by Helicobacter-like organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Non-steroidal anti-inflammatory drug-induced disease in the distal ileum and large bowel

Non-steroid, anti-inflammatory drug (NSAID)-induced lesions in the gut are common, but so far most focus has been placed on the gastroduodenal mucosa. However, an increasing number of reports describe deleterious effects on the distal gut as well. Findings range from asymptomatic mucosal inflammation to stricture and obstruction, perforations, and major hemorrhages. Induction and exacerbation of inflammatory bowel disease has also been noted for most of the commercially available NSAIDs. Although final proof of a causal relationship is lacking, the indices present strongly suggest such a connection. The mechanism is largely unknown, although inhibition of cyclooxygenase with subsequent depletion of endogenous prostanoid synthesis has been suggested as a mediator. If surgery can be avoided, stopping the NSAID therapy is often sufficient to obtain lasting remission. The main point is knowledge of this facet of NSAID use, so that the pertinent drug history is obtained. Determination of the distal gut effects should probably also be included in the evaluation of present and future NSAIDs.