Peptic Ulcers in Rheumatoid Patients Receiving Corticosteroid Therapy

Drug-induced gastrointestinal disease

“…Generally peptic ulcers in corticosteroid-treated patients tend to show a predominance of gastric (usually antral) over duodenal ulcers, the reverse of the control population [25,34]. However, the description of the individual ulcer ranges from large and deep [34], to shallow [25], to indistinguishable from idiopathic ulcers [35]. There has been general agreement that peptic ulcers in steroid patients show less surrounding edema, spasm, and scarring, perhaps related to the anti-inflammatory effect of the corticosteroids [25,36,37].…”

“…Generally peptic ulcers in corticosteroid-treated patients tend to show a predominance of gastric (usually antral) over duodenal ulcers, the reverse of the control population [25,34]. However, the description of the individual ulcer ranges from large and deep [34], to shallow [25], to indistinguishable from idiopathic ulcers [35].…”

“…It has been commonly taught that corticosteroids are associated with peptic ulcer disease, particularly gastric ulcer; early reports of the association were frequent in the radiologic literature [24][25][26][27]. However, other reports found no significant relationship [28,30].…”

“…However, the description of the individual ulcer ranges from large and deep [34], to shallow [25], to indistinguishable from idiopathic ulcers [35]. There has been general agreement that peptic ulcers in steroid patients show less surrounding edema, spasm, and scarring, perhaps related to the anti-inflammatory effect of the corticosteroids [25,36,37]. Some reports have emphasized the relatively silent nature of peptic ulcer disease in patients on corticosteroids and an associated high complication rate from bleeding and perforation, but no obstruction (decreased inflammatory response) [25,34,36].…”

“…There has been general agreement that peptic ulcers in steroid patients show less surrounding edema, spasm, and scarring, perhaps related to the anti-inflammatory effect of the corticosteroids [25,36,37]. Some reports have emphasized the relatively silent nature of peptic ulcer disease in patients on corticosteroids and an associated high complication rate from bleeding and perforation, but no obstruction (decreased inflammatory response) [25,34,36]. The possibility of colonic perforation related to corticosteroid use has also been raised, both in a diseased colon involved with diverticulitis or ulcerative colitis and in an otherwise normal colon presenting with punched out ulcerations [29,38,39].…”