Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers

Smedley, F.; Taube, Mari Jane; Leach, R D; Wastell, C

doi:10.1136/pgmj.65.770.892

Cited by 21 publications

(5 citation statements)

References 15 publications

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“…Smedley and colleagues, however, showed that NSAID use was only associated with 12% of duodenal ulcer perforations and 13% of duodenal ulcer bleeding. They also reported several older studies with similar results [ 6 ].…”

Section: Discussionsupporting

confidence: 71%

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation

Bruner

Gustafson

2011

Int J Emerg Med

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BackgroundDyspnea and chest pain are common presenting complaints to the ED, and coupled together can present a challenging diagnostic dilemma in patients in extremis. A thoughtful evaluation is required, giving due diligence to the immediate life threats as well as multiple etiologies which can cause serious morbidity. A perforated peptic ulcer is one such possibility and requires rapid diagnosis and prompt intervention to avoid the associated high risk of morbidity and mortality.MethodWe present a case report of a 54 year old man with respiratory distress and chest pain as the initial Emergency Department presentation of a perforated duodenal ulcer.ResultsWe discuss an unusual presentation of a perforated duodenal ulcer that was recognized in the emergency department and treated promptly. The patient was surgically treated immediately, had a prolonged and complicated post-operative course, but is ultimately doing well. We also provide a brief literature review of the risk factors, imaging choices, and management decision required to treat a perforated ulcer.ConclusionsPerforated ulcers can have highly varied presentations and are occasionally difficult to diagnose in a complicated patient. Knowledge of the risk factors and a thorough history and physical can point to the diagnosis, but timely and appropriate imaging is often required because delays in diagnosis and treatment lead to poor outcomes. Early administration of antibiotics and immediate surgical repair are necessary to limit morbidity and mortality.

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Section: Discussionsupporting

confidence: 71%

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation

Bruner

Gustafson

2011

Int J Emerg Med

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“…Duodenal lesions are less common than gastric ulcers. Not only are elderly patients more likely than younger patients to develop NSAID-associated gastropathy, they are also more likely to have bleeding and perforations of ulcers (Armstrong & Blower 1987;Collier & Pain 1985;Faulkner et al 1988;Griffin et al 1991;Laporte et al 1991;Smedley et al 1989;Somerville et al 1986;Walt et al 1986), leading to increased mortality (Griffin et al 1988). Not only are elderly patients more likely than younger patients to develop NSAID-associated gastropathy, they are also more likely to have bleeding and perforations of ulcers (Armstrong & Blower 1987;Collier & Pain 1985;Faulkner et al 1988;Griffin et al 1991;Laporte et al 1991;Smedley et al 1989;Somerville et al 1986;Walt et al 1986), leading to increased mortality (Griffin et al 1988).…”

Section: Gastrointestinal Toxicitymentioning

confidence: 99%

Rheumatoid Arthritis in the Aged

Nesher

Moore²

1993

Drugs & Aging

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Rheumatoid arthritis (RA) is estimated to occur in 0.3 to 3% of the general population. Up to one-third of RA patients first present for treatment after the age of 60 years (elderly-onset RA). The overall frequency in individuals older than 65 is increased, so that 30 to 40% of RA patients treated in rheumatology centres are > 60 years of age. Optimal management of all RA patients includes physical therapy, medications, both nonsteroidal anti- inflammatory drugs (NSAIDs) and remittive agents, and, in some cases, surgery. In the elderly, these treatment modalities at times need to be altered to accommodate age-related changes in body mechanics and organ function. Thus, the approach to physical therapy in older patients is different than in the young. There are fewer rest periods and more passive exercises. Drug treatment must also be modified, since NSAIDs and several remittive agents are more hazardous in elderly patients. Indications for orthopaedic procedures may also be different. The long term management of RA requires a delicate balance of benefit and risk. It is wise to begin with the least toxic medications. However, if necessary, potentially toxic medications can be given cautiously, with close monitoring for adverse effects.

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“…and also contributory to. the increasing age of pre sentation [47,48], The anti-inflammatory na ture of these drugs, decreasing oedema and reducing the accumulation of granulocytes at the focus of inflammation may well slow down, or inhibit, spontaneous sealing in those patients treated non-operatively [49].…”

mentioning

confidence: 99%

Perforated Peptic Ulcer – The Changing Scene

Cocks¹

1992

Dig Dis

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There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A ‘deliberative’ approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surgery.

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Non-steroidal anti-inflammatory drug ingestion: retrospective study of 272 bleeding or perforated peptic ulcers

Cited by 21 publications

References 15 publications

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation

Respiratory distress and chest pain: a perforated peptic ulcer with an unusual presentation

Rheumatoid Arthritis in the Aged

Perforated Peptic Ulcer – The Changing Scene

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