Gastroscopic evaluation of anti-inflammatory agents

Caruso, I; Porro, G. Bianchi

doi:10.1136/bmj.280.6207.75

Cited by 305 publications

(71 citation statements)

References 19 publications

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“…This procedure can only be used intermittently and may underestimate damage since measurements are only obtained over 10 min and are limited to the v stomach. Endoscopy gives the most direct impression of gastric damage (Caruso & Bianchi Porro, 1980) but can only be performed acutely or at most infrequently during long term treatment, whereas no information is obtained about possible damage to parts of the small intestine that cannot be visualised (Bjarnason et al, 1984). Immunological detection of intact haemoglobin in the faeces (Frommer et al, 1988) is of limited use for the detection of effects of NSAIDs since the haemoglobin from the upper gastrointestinal tract reaches the faeces mainly as porphyrins, which are not recognised by the antibody.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Cohen

Boeijinga

Haard

et al. 1992

Brit J Clinical Pharma

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1. A method for the detection of gastrointestinal blood loss based upon the selective measurement of faecal porphyrins was tested in two studies in healthy volunteers. 2. In the first study subjects (n = 6) received intragastric autologous blood (saline, 2 and 6 ml as a single dose) resulting in a dose dependent increase in faecal porphyrins. 3. In a subsequent placebo controlled cross over study in 12 subjects acetylsalicylic acid (ASA), nabumetone (a new NSAID) or placebo were administered for 5 days with a washout period of 9 days. They were no dietary restrictions. 4. All faeces were collected during the treatment period and both the full faecal homogenate and a random faecal sample were analyzed for deutero‐ and pemptoporphyrin content by h.p.l.c. Additionally a benzidine reaction was performed. 5. There was a highly significant correlation (r = 0.95) between the values obtained from random samples and the full homogenate. ASA increased the faecal porphyrin excretion (P less than 0.001) compared with placebo in contrast to nabumetone. Complaints of dyspepsia were most common after ASA. 6. Measurement of faecal porphyrins is useful for monitoring NSAID induced upper gastrointestinal blood loss and lacks some of the practical constraints of other methods.

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Cohen

Boeijinga

Haard

et al. 1992

Brit J Clinical Pharma

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“…Design-Double blind, placebo controlled, randomised, parallel group with endoscopic assessments at 0, 4, and 8 weeks.…”

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confidence: 99%

Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine.

Ehsanullah

Page

Tildesley

et al. 1988

BMJ

359

118

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Objective-To evaluate the prophylactic effect of ranitidine 150 mg twice daily in patients requiring one of the following non-steroidal anti-inflammatory drugs: naproxen, piroxicam, diclofenac, and indomethacin. In addition, risk factors were studied in order to help in targeting of such treatment to specific groups of patients.Design-Double blind, placebo controlled, randomised, parallel group with endoscopic assessments at 0, 4, and 8 weeks.Setting-Multicentre outpatient study at secondary referral centres in five European countries.Patients-297 patients with rheumatoid arthritis or osteoarthritis over the age of 18 without lesions in the stomach and duodenum at baseline endoscopy (after one week without taking non-steroidal antiinflammatory drugs). Those taking other antirheumatic agents, concomitant ulcerogenic drugs, or treatment for peptic ulcers within the previous 30 days were excluded. Age, sex, arthritic disease, and type of non-steroidal anti-inflammatory drug used were comparable in the two treatment groups. In all, 263 patients completed the trial.Interventions-Ranitidine 150 mg twice daily or placebo (plus the selected non-steroidal antiinflammatory drug) was prescribed within five days after the baseline endoscopy for two consecutive periods of four weeks. Paracetamol was permitted during the study, but not antacids. Patients were withdrawn if the most severe grade of damage (including ulceration) was found at the four week endoscopy or when indicated, or with lesser damage at the investigator's discretion.End point-Frequency of gastric and duodenal ulceration or lesions, or both.Measurements and main results-The cumulative incidence of peptic ulceration by eight weeks was 10-3% (27/263); 2 out of 135 (1-5%) developed duodenal ulceration in the ranitidine group, compared with 10 out of 126 (8%) taking placebo. The frequency ofgastric ulceration was the same (6%) for the two groups at eight weeks. Though significantly fewer gastric lesions developed in the ranitidine group by four weeks, this difference was not evident by eight weeks. The frequency of non-ulcerative lesions in the duodenum did not differ greatly for the two groups at either time point. Twelve out of 75 (16%) patients taking piroxicam developed peptic ulceration, of whom two thirds had duodenal ulceration. Patients with a history of peptic ulcer were particularly susceptible to recurrent ulceration, against which ranitidine offered some protection.Conclusions-Ranitidine 150 mg twice daily significantly reduced the incidence of duodenal ulceration but not gastric ulceration when prescribed concomitantly with one of four commonly used non-steroidal anti-inflammatory drugs.

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“…In general, clinically relevant symptoms after the administration of NSAIDs occur in 25% to 30% of patients, and in those over 65 years the incidence is between 31% and 38%. 31 Lesions of the mucosa may occur without symptoms. [31][32][33] We excluded patients with previous symptoms suggestive of ulceration.…”

Section: Discussionmentioning

confidence: 99%

“…31 Lesions of the mucosa may occur without symptoms. [31][32][33] We excluded patients with previous symptoms suggestive of ulceration. Conclusions.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Heterotopic Ossification After Total Hip Replacement

Knelles

Barthel

Karrer

et al. 1997

The Journal of Bone and Joint Surgery. British volume

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We have carried out a prospective, randomised study of prophylaxis for heterotopic ossification (HO) comparing indomethacin for 7 and 14 days, acetylsalicylic acid, and fractional (4 ‫ן‬ 3 Gy) or single exposure of 5 or 7 Gy irradiation after operation.We initially had 723 patients (733 hip replacements), but after withdrawals there were 685 hips of which 18.4% developed HO; 14% were grade I, 2.9% grade II and 1.5% grade III of the Brooker classification.We compared the results between these groups with those of a matched control series and found that indomethacin, 2 ‫ן‬ 50 mg for 7 and 14 days, and postoperative irradiation of 4 ‫ן‬ 3 Gy or 1 ‫ן‬ 7 Gy, significantly reduced the development of HO compared with the control group. Patients in the acetylsalicylic acid group and those with a single irradiation of 5 Gy after operation developed significantly more ossification than those in the indomethacin and other irradiation groups.We suggest the use of 2 ‫ן‬ 50 mg of indomethacin with mucoprotection for seven days as prophylaxis against HO after total hip replacement for all patients. A single irradiation of 7 Gy is recommended for patients who have developed HO after previous operations or to whom administration of indomethacin is contraindicated.

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Gastroscopic evaluation of anti-inflammatory agents

Cited by 305 publications

References 19 publications

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine.

Prevention of Heterotopic Ossification After Total Hip Replacement

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