Association of Adrenocorticosteroid Therapy and Peptic-Ulcer Disease

Messer, Julio; Reitman, Dinah; Sacks, Henry S.; Smith, Harry; Chalmers, Thomas C.

doi:10.1056/nejm198307073090105

Cited by 390 publications

(142 citation statements)

References 17 publications

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“…9,16 Several studies have been done to support the adverse effect of steroid therapy on adrenal axis, peptic ulcer disease, infections, skin, bone mineral density, fractures. [17][18][19][20][21][22][23][24] Glucose control is more difficult with steroid based therapy in COPD. [25][26][27] One study shows 15% of COPD patient requires additional treatment for hyperglycemia as compared to 4% of control group.…”

Section: Introductionmentioning

confidence: 99%

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

Verma¹,

Nim²,

Kumar³

et al. 2017

Int J Res Med Sci

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Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Among the pharmacological therapy, inhaled betaagonist and anticholinergics are the mainstay therapy of COPD along with corticosteroid. Steroid therapy is associated with various potential adverse effects like steroid induced deranged glycemic status. So, we sought to examine the association between long term corticosteroid therapy and glycemic status in COPD patients. Methods: A cross sectional study was done to assess the glycemic status in COPD patients on long term corticosteroid therapy in a rural tertiary care centre on patients satisfying inclusion and exclusion criteria. Inclusion criteria includes COPD patients on steroid based therapy (inhaled/systemic or both) for at least 6 months. Known case of type 2 diabetes mellitus, bronchial asthma, interstitial lung disease, coronary artery disease, cardiomyopathies, connective tissue disorders, recipients of organ transplant or immunosuppressive therapy, patients having co morbidities like renal failure, liver failure, heart failure and patients on other drugs known to cause hyperglycemia were excluded. Random blood sugar, HbA1C etc, was done and data was analyzed by SPSS version 22.0. Results: Total 46 patients were included in study. Mean age was 63.22 years with minimum age 47 years and maximum age 80 years. 35 patients (76.09%) were male and 11 patients (23.91%) were female. Sex ratio was 3.18:1. 26 patients (56.52%) were taking both inhaled and systemic corticosteroids, 12 patients (26.09%) were taking only inhaled corticosteroids and 8 patients (17.39%) were taking systemic corticosteroid therapy. 14 patients (30.43%) were found to have impaired glucose tolerance, 7 patients (15.22%) were diagnosed as a case of diabetes mellitus and 25 patients (54.35%) were found to be euglycemic. Conclusions: We conclude that incidence of deranged glycemic status is more common among COPD patients receiving only systemic corticosteroid therapy or both systemic and inhaled corticosteroid therapy. Further, inhaled corticosteroids are better in terms of glycemic control among COPD patients on corticosteroid therapy. Hence, we recommend routine screening of glycemic status in COPD patients on corticosteroid therapy.

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Section: Introductionmentioning

confidence: 99%

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

Verma¹,

Nim²,

Kumar³

et al. 2017

Int J Res Med Sci

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“…Both positive and negative associations between the use of glucocorticoids and gastrointestinal bleeding have been found (20,(23)(24)(25)(26). Although the investigations of gastrointestinal side effects of glucocorticoid therapy alone revealed inconsistent results, current evidence indicates a risk of peptic ulcer up to 15 times greater in patients concurrently receiving glucocorticoids and NSAIDs (20).…”

mentioning

confidence: 99%

Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

Thiele¹,

Buttgereit²,

Huscher³

et al. 2005

Arthritis & Rheumatism

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Objective. To describe the current use of glucocorticoids in German patients with rheumatoid arthritis (RA). Methods. We analyzed clinical and patient-derived data from 10,068 outpatients with RA from the national database of the German Collaborative Arthritis Centres for the year 2001 collected by more than 80 rheumatologists in hospitals and private practices. Results. Systemic glucocorticoid therapy was prescribed for 60% of all patients with RA in rheumatologic care. The proportion of patients receiving systemic glucocorticoids in addition to disease-modifying antirheumatic drug (DMARD) therapy ranged from 53% to 81% of the patients for the various DMARDs. Glucocorticoid therapy was administered more often in combination with tumor necrosis factor inhibitors (81%), cyclosporin A (80%), or leflunomide (77%) than with more traditional DMARDs such as methotrexate (63%) or sulfasalazine (55%). Regarding the prevention and treatment of osteoporosis, 63% of patients taking systemic glucocorticoids were also receiving some type of osteoporosis therapy, as opposed to only 26% of those not taking glucocorticoids. Conclusion. Glucocorticoids play a pivotal role in the management of RA. This is reflected in the extensive use of low-dose glucocorticoids by German rheumatologists. Even if highly effective DMARDs are prescribed, they are accompanied by glucocorticoids, at least in the initial phase. High-dose glucocorticoids are prescribed for only a small proportion of the patients. There is increasing awareness of the risk of osteoporosis in long-term glucocorticoid treatment, demonstrated by the fact that osteoporosis medication is prescribed for a large proportion of patients taking glucocorticoids.

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“…A corticoterapia prolongada induz a leve incremento da produção de ácido clorídrico pela mucosa gástrica; entretanto, não existe aumento na incidência de úlceras pépticas, de acordo com dados recentes, exceto naqueles indivíduos recebendo antiinflamatórios não-esteróides concomitantemente 39 .…”

Section: ) Gastrointestinalunclassified

Efeitos sistêmicos e síndrome de retirada em tomadores crônicos de corticosteróides

Faiçal¹,

Uehara²

1998

Rev. Assoc. Med. Bras.

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A indicação do corticosteróide na terapêutica da artrite reumatóide, por Philip Hench, em 1949, foi um dos marcos dentro da medicina. O glicocorticóide é assim denominado pelos seus conhecidos efeitos sobre o metabolismo dos carboidratos; porém, este hormônio possui outras ações além desta que é a mais lembrada 1 . Essas propriedades são mediadas por receptores intracelulares denominados receptor de glicocorticóide 2 ; entretanto, algumas delas são mediadas por meio de receptores mineralocorticóides 3 . O modo pelo qual o glicocorticóide atinge seu receptor parece ser devido à provável difusão passiva por meio da membrana lipídica, não necessitando de transporte específico para tal 2 .A utilização prolongada dos corticosteróides leva à síndrome de Cushing iatrogênica, caracterizada pela desfiguração cosmética (moon face, giba dorsal, estrias), ganho de peso com acúmulo de gordura centripetamente, redução da tolerância a carboidratos, fragilidade vascular, pele fina, miopatia e fraqueza muscular, hipertensão arterial, osteoporose, maior suscetibilidade a infecções, alterações psiquiátricas, e outros. A maior diferença desta síndrome exógena, em relação ao hipercortisolismo endógeno, constitui na maior ação mineralocorticóide existente neste último, resultando em mais hipertensão arterial e, ocasionalmente, hipocalemia e hirsutismo e/ou virilização, principalmente quando secundário a tumores adrenais. Além disso, alguns efeitos menos comuns, como a hipertensão intracraniana benigna, necrose avascular óssea e glaucoma, teriam maior relação com a síndrome de Cushing iatrogênica do que com o hipercortisolismo endógeno 4 .Os efeitos colaterais de uma mesma dose de corticosteróide são heterogêneos entre os indiví-duos de uma população; os motivos para esta heterogeneidade são, provavelmente, a cinética ou as diferentes concentrações plasmáticas das proteínas carreadoras desses fármacos 4 . Essas diferenças podem ser observadas em alterações da depuração, como sua diminuição encontrada em hepatopatias, nefropatias, terapia estrogênica, uso de cetoconazol, alguns antiinflamatórios e em idosos, ou sua aceleração secundária ao uso de fenitoína, fenobarbital e rifampicina 5,6 . Variados esquemas terapêuticos têm sido propostos com o intuito de minimizar os efeitos deleté-rios advindos de seu uso crônico, dos quais o mais efetivo é seu emprego em dias alternados, que, praticamente, não influi sobre o eixo hipotálamo-hipófise-adrenal e a velocidade de crescimento das crianças. No entanto, a incidência de osteoporose não é reduzida, apesar dessas tentativas 5,7,8 . Cabe realçar que a diferença observada entre os esquemas está na dependência de fatores como dose, horário, tipo da droga e tempo de uso dos corticóides. EFEITOS NO METABOLISMO INTERMEDIÁRIOO metabolismo intermediário é influenciado globalmente pelos glicocorticóides, não apenas sobre os glicídios, como sugere seu nome, mas também sobre protídios e lipídios.A alteração mais comum no metabolismo dos hidratos de carbono devido ao excesso de glicocorticóides é tendênci...

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Association of Adrenocorticosteroid Therapy and Peptic-Ulcer Disease

Cited by 390 publications

References 17 publications

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

Current use of glucocorticoids in patients with rheumatoid arthritis in Germany

Efeitos sistêmicos e síndrome de retirada em tomadores crônicos de corticosteróides

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