Symptoms in Patients with Peptic Ulcer and Hematemesis and/or Melena Related to the Use of Non-Steroid Anti-Inflammatory Drugs

Mellem, H; Stave, R; Myren, J; Osnes, M; Hanssen, L. E.; Mosvold, J; Hebnes, K.

doi:10.3109/00365528509089284

Cited by 67 publications

(14 citation statements)

References 11 publications

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“…The lack of correlation between subjective symptoms and endoscopically observed mucosal lesion scores is in agreement with other contemporary reports (7,10,23) and with the clinical observation that serious GI haemorrhage due to an NSAID may occur without prior symptoms (12). This rather disturbing phenomenon may indicate that subjective symptoms reported by patients are a rather unreliable indicator of severe side effects of NSAIDs.…”

Section: Discussionsupporting

confidence: 78%

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Optimal Assessment of Gastrointestinal Side Effects Induced by Non-Steroidal Anti-Inflammatory Drugs: Endoscopic Lesions, Faecal Blood Loss, and Symptoms Not Necessarily Correlated, As Observed after Naproxen and Oxindanac in Healthy Volunteers

Aabakken

Dybdahl

Eidsaunet

et al. 1989

Scandinavian Journal of Gastroenterology

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Gastrointestinal side effects caused by naproxen and oxindanac (a developmental non-steroidal anti-inflammatory drug) were compared by combined endoscopy and determination of faecal blood loss in 16 healthy male volunteers in a randomized, double-blind, crossover study. Individual daily faecal blood loss was determined by means of 51Cr-labelled erythrocytes. Gastroduodenoscopy was performed before and after administration of naproxen, 750 mg/day, and oxindanac, 600 mg/day, for 1 week each. A washout period of at least 3 weeks was inserted between drug periods. Visual analogue scales (VAS) were used for endoscopic assessment of lesions and subjective complaints. Mean faecal blood loss increased from a base line 0.48 ml/24 h to 1.59 ml/24 h with naproxen (p less than 0.01) and from 0.56 ml/24 h to 1.31 ml/24 h with oxindanac (p less than 0.01). VAS scores for gastroduodenal lesions increased significantly with both drugs. Naproxen caused a significantly greater increase than oxindanac (p less than 0.05). There was no correlation between gastrointestinal blood loss and endoscopic findings. Subjective symptoms were correlated to faecal blood loss with naproxen, but not to endoscopic findings. No such correlations were observed for oxindanac. Naproxen caused a significant prolongation of bleeding time (p less than 0.01), whereas the increase caused by oxindanac was not significant (p = 0.09).

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Section: Discussionsupporting

confidence: 78%

“…Subjective gastrointestinal side effects are a poor indicator of possible complications of NSAID therapy (12). We therefore wanted to optimize the evaluation of G T effects of NSAIDs, emphasizing the comparison of endoscopic assessment and faecal blood loss and their possible relation to reported symptoms.…”

mentioning

confidence: 99%

Optimal Assessment of Gastrointestinal Side Effects Induced by Non-Steroidal Anti-Inflammatory Drugs: Endoscopic Lesions, Faecal Blood Loss, and Symptoms Not Necessarily Correlated, As Observed after Naproxen and Oxindanac in Healthy Volunteers

Aabakken

Dybdahl

Eidsaunet

et al. 1989

Scandinavian Journal of Gastroenterology

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“…The association between NSAID and silent peptic ulcer has been studied for long time, but still remains in debate. The majority of the literature supported the role of NSAID in developing silent peptic ulcer by masking ulcer pain [13][14][15][16]. However, these findings were almost all derived by univariate analyses without adjusting confounding factors such as age and sex.…”

Section: Discussionmentioning

confidence: 83%

NSAID is inversely associated with asymptomatic gastric ulcer: Local health examination data from the Korean National Health Insurance Corporation

Kim¹,

Cho²,

Choi³

et al. 2013

Scandinavian Journal of Gastroenterology

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BACKGROUND. Silent peptic ulcer has been considered to be associated with nonsteroidal anti-inflammatory drug (NSAID). The recent studies have reported no relationship between them. AIM. We attempted to investigate an association between asymptomatic peptic ulcer and NSAID in Korean adults. METHODS. The subjects were enrolled from participants visiting Myongji Hospital for health examination program of the Korean National Health Insurance Corporation. The questionnaires were designed to investigate individual medical information and gastroduodenal symptoms. RESULTS. From May 2005 to March 2009, 5459 participants were enrolled and 299 participants were excluded. Of 5160 participants, 3144 (60.9%) participants were asymptomatic and 424 (8.2%) participants had peptic ulcer. Among 3144 asymptomatic participants, NSAID-taking participants had the odds ratio of 1.4 [95% confidence interval (CI): 0.7-2.6, p = 0.339] for the risk of peptic ulcer. Among 424 peptic ulcer patients, 247 (58.3%) were asymptomatic. They had lower prevalence of NSAID use (4.9% vs. 14.7%). The asymptomatic gastric ulcer patients had smaller size and more frequent healing stage than the symptomatic gastric ulcer patients. In multivariable analysis of 424 peptic ulcer patients, NSAID patients had the odds ratio of 0.249 (95%CI: 0.115-0.536, p < 0.05) for asymptomatic peptic ulcer. In subgroup analysis of 284 gastric ulcer patients, NSAID-taking patients had the odds ratio of 0.263 (95% CI: 0.105-0.657, p = 0.004) for asymptomatic peptic ulcer. CONCLUSION. NSAID has an inverse association with asymptomatic patients with gastric peptic ulcer, but has no association with gastroduodenal symptoms in duodenal ulcer patients. These suggest that NSAID may be associated with gastroduodenal symptoms rather than masking symptoms, at least in gastric ulcer patients.

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“…The exact cause of the obscure manifestations of these GI pathologies in DM remains unclear. An overall hyposensitivity due to visceral neuropathy, altered central processing to visceral stimulation, and frequent antiplatelet use in diabetic patients has been suggested (5,28,29). Recent studies further demonstrated a reduced density and abnormal morphology of gastric mucosal nerve fibers in both type 1 and type 2 diabetic subjects (30,31).…”

Section: Discussionmentioning

confidence: 99%

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

et al. 2012

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OBJECTIVETo determine the prevalence of gastrointestinal (GI) manifestations associated with diabetes mellitus (DM) in a Taiwanese population undergoing bidirectional endoscopies.RESEARCH DESIGN AND METHODSSubjects voluntarily undergoing upper endoscopy/colonoscopy as part of a medical examination at the National Taiwan University Hospital were recruited during 2009. Diagnosis of DM included past history of DM, fasting plasma glucose ≥126 mg/dL, or glycated hemoglobin (HbA1c) ≥6.5%. Comparisons were made between diabetic and nondiabetic subjects, subjects with lower and higher HbA1c levels, and diabetic subjects with and without complications, respectively, for their GI symptoms, noninvasive GI testing results, and endoscopic findings.RESULTSAmong 7,770 study subjects, 722 (9.3%) were diagnosed with DM. The overall prevalence of GI symptoms was lower in DM subjects (30.3 vs. 35.4%, P = 0.006). In contrast, the prevalence of erosive esophagitis (34.3 vs. 28.6%, P = 0.002), Barrett's esophagus (0.6 vs. 0.1%, P = 0.001), peptic ulcer disease (14.8 vs. 8.5%, P < 0.001), gastric neoplasms (1.8 vs. 0.7%, P = 0.003), and colonic neoplasms (26.6 vs. 16.5%, P < 0.001) was higher in diabetic subjects. Diagnostic accuracy of immunochemical fecal occult blood test for colonic neoplasms was significantly decreased in DM (70.7 vs. 81.7%, P < 0.001). Higher HbA1c levels were associated with a decrease of GI symptoms and an increase of endoscopic abnormalities. Diabetic subjects with complications had a higher prevalence of colonic neoplasms (39.2 vs. 24.5%, P = 0.002) than those without.CONCLUSIONSDM and higher levels of HbA1c were associated with lower prevalence of GI symptoms but higher prevalence of endoscopic abnormalities.

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Symptoms in Patients with Peptic Ulcer and Hematemesis and/or Melena Related to the Use of Non-Steroid Anti-Inflammatory Drugs

Cited by 67 publications

References 11 publications

Optimal Assessment of Gastrointestinal Side Effects Induced by Non-Steroidal Anti-Inflammatory Drugs: Endoscopic Lesions, Faecal Blood Loss, and Symptoms Not Necessarily Correlated, As Observed after Naproxen and Oxindanac in Healthy Volunteers

Optimal Assessment of Gastrointestinal Side Effects Induced by Non-Steroidal Anti-Inflammatory Drugs: Endoscopic Lesions, Faecal Blood Loss, and Symptoms Not Necessarily Correlated, As Observed after Naproxen and Oxindanac in Healthy Volunteers

NSAID is inversely associated with asymptomatic gastric ulcer: Local health examination data from the Korean National Health Insurance Corporation

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

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