Upper Gastrointestinal Bleeding in Children: The Role of Helicobacter pylori Infection and Non-steroidal Anti-inflammatory Drug Use. W INDIAN MED J. 2015;64. [PMID: 26360683 DOI: 10.7727/wimj.2014.130]

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

Etiology of upper gastrointestinal bleeding in soldiers living in sea islands

AIM: To investigate the etiology of upper gastrointestinal bleeding (UGIB) in soldiers living in sea islands.

METHODS: The possible etiologies of 146 patients with UGIB were retrospectively collected. The differences in clinical data between soldiers and non-soldiers were compared, such as the percentages of patients with peptic ulcers, esophageal gastric varices and cancer.

RESULTS: Compared with non-soldiers, soldiers with UGIB who were living in sea islands had more males and were younger. The stomach and duodenum were the more common bleeding sites in soldiers. 85.2% of UGIB soldiers had peptic ulcers, which were higher than 33.6% in non-soldiers with UGIB (P < 0.001). Esophageal gastric varices was less common in UGIB soldiers compared with non-soldiers (3.7% vs 35.3%). The frequencies of NSAIDs-related and cancer-related bleeding between the two groups were similar. 96.3% of soldiers and 92.7% of non-soldiers underwent successful conservative management (P = 0.671).

CONCLUSION: The etiologies of UGIB in soldiers living in sea islands are different from those of non-soldiers. Peptic ulcers are common but esophageal gastric varices is less common in soldiers living in sea islands. The prognosis for most UGIB soldiers is good.