Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

Abstract

AIM:To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics. METHODS:The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group Ⅰ) with suicidal intent. Thirty patients with or without mild complaints of dyspepsia (group Ⅱ) were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score (LS), expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis. RESULTS: Gastroduodenal damage was significantly more severe in group Ⅰ compared to group Ⅱ (P < 0.01). The LS was similar in both groups Ⅰa and Ⅰb. However LS was significantly higher in patients who had ingested multiple NSAIDs (group Ⅰc) compared to other patients (P < 0.01). The LS was correlated to age (P < 0.01) and total amount of drug ingested (P < 0.05) in group Ⅰ; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P > 0.05). The biopsy score (BS) was higher in group Ⅰ than group Ⅱ (P < 0.01), and higher in group Ⅰb than group Ⅰa (P < 0.05). CONCLUSION: The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of highdose acetaminophen.

THE EFFECTS OF BANANA STEM (Musa paradisiaca var. sapientum) EXTRACT ON HISTOPATHOLOGIC GASTRIC OF RATS INDUCED BY INDOMETACHIN

“…The results showed the highest level of epithelial erosion on (K+). These results are quite similar to the statement of Soylu et al (2008), that indomethacin inhibits the activity of the enzyme COX-1. Inhibition of COX-1 by indomethacin will reduce prostaglandin formation of gastric mucosa.…”

The Incidence of Upper Gastrointestinal Complications of Non-Steroidal Anti-Inflammatory Drugs in Elderly Patients

“…There was strong correlation between the age and the incidence of ulcer in patients receiving Ibuprofen as reported by Soylu A et al& Hernandez D [15][16]. But, our results provided that the incidence of ulcer not correlated to the age.…”

“…In contrast, Yuan YH et al concluded after reviewing randomized placebocontrolled trials of oral NSAIDs from 1975 to 2006, that the incidence of gastrodudenal ulcer in placebo arms has not changed significantly over the last three decades [14]. Similarly, Soylu A et al reported the absence of that statistically significant difference [15].…”

“…In the contrary, it has been concluded that there was strong correlation between the daily dose of Ibuprofen and the incidence of ulcer [15][16][17].…”

Stress ulcer prophylaxis guidelines: Are they being implemented in Lebanese health care centers?

“…Those patients were not included in our study since it is not known if a history of GI ulcerations and bleeding increases the risk of acute stress-induced bleeding [8,9] . Similarly, NSAIDs were not thoroughly studied as risk factors for stress ulcers although their longterm use was associated with GI bleeding problems [37][38][39] ; (5) Current GI bleeding: Patients with active GI bleeding were also excluded from the study since those patients will be receiving AST as a pharmacologic intervention for the management of upper GI bleeding. Moreover, prophylaxis has no role and is not indicated in this population [40][41][42] ; (6) Lab tests including complete blood count, liver function tests and stool exam were documented to monitor for bleeding [43][44][45] ; (7) Stress ulcers risk factors: A stress ulcer risk stratification, adopted from the ASHP guidelines, divided patients into three categories: non-critically ill medical patients, ICU populations and pediatrics.…”