Peptic ulcer in rheumatoid patients on corticosteroid therapy. A clinical, experimental and radiologic study

Abstract

An extensive study of the relationship of peptic ulcer to adrenal steroid therapy has led to the conclusion that certain corticosteroids are responsible for gastric ulceration, probably as a result of direct effects on the mucosa. Peptic ulcer was observed radiographically in 31 per cent of patients with rheumatoid arthritis receiving adrenal steroids but in only 9 per cent of patients not treated and 5 per cent of nonrheumatoid controls. Hydrochloric acid and pepsin secretion were not influenced significantly by the administration of corticosteroids. Un extense studio del relation inter ulcere peptic e therapia adreno‐steroide ha resultate in le conclusion que certe corticosteroides es responsabile pro ulceration gastric, probabilemente in consequentia de effectos directe super le mucosa. Ulcere peptic esseva observate radio‐graphicamente in 31 pro cento de patientes con arthritis rheumatoide qui recipeva steroides adrenal sed solmente in 9 pro cento de tal patientes qui non recipeva steroides adrenal e in 5 pro cento de non‐rheumatoide subjectos de controlo. Le secretion de acido hydrochloric e de pepsina non esseva influentiate a grados significative per le administration de corticosteroides.

A Comparison of Prednisolone with Aspirin or other Analgesics in the Treatment of Rheumatoid Arthritis: M. R. C. Report

“…This may be compared with reported ulcer rates ranging from 31 per cent. (Kammerer, Freiberger, and Rivelis, 1958) to 5-3 per cent. (Henderson, 1955) in patients with rheumatic disease treated with corticosteroids.…”

Gastric ulcer and the anti-arthritic drugs

“…This unusual distribution of the site of ulceration is the most convincing evidence of a direct association between steroid therapy and the ulcer. It is well illustrated by the prospective studies of Kammerer et al (1958) and Gedda & Moritz (1959). In their combined series, forty-one out of forty-nine ulcers were gastric, and this accentuates the difference as compared with the incidence in their controls examined by radiology or at autopsy.…”

“…Although prolonged steroid therapy may give rise in some individuals to an increase in gastric acid secretion (Gray et al, 1953;Crean, 1960), most of the literature on 'steroid ulcer' stresses that a reduction of mucosal resistance is the main factor. Hirschowitz et al (1955) and Kammerer et al (1958) recorded a decrease in the viscosity of gastric juice and the former reported a reduction in stainable mucus on the gastric surface.…”

“…Bearing in mind all the variables mentioned earlier, one must still consider the massive evidence of correlation between peptic ulcer and steroid therapy (Kern, Clark & Lubens, 1957;Black, Yielding & Bunlin, 1958;Howell & Ragan, 1956;Edgecomb, 1958;Kammerer, Frieberger & Rivelis, 1958;Evans, 1958;Gedda & Moritz, 1959). The incidence of peptic ulcer in these series ranged from 12-5 to 31%.…”

Rheumatology and the Gastrointestinal Tract

“…Table 6, from a paper by Kammerer and co‐workers (6) published in the same year, shows that in patients receiving steroid therapy who had had arthritis for less than ten years the incidence of peptic ulcer was 26 per cent; in those who had had arthritis for eleven to twenty years the incidence of ulcer was 31 per cent; and in those who had had arthritis for more than twenty years the incidence of ulcer was 44 per cent. The overall incidence in 117 patients was 31 per cent, whereas in the patients who had not received steroid therapy the overall figure was 9 per cent.…”