Upper gastrointestinal disease in rheumatoid arthritis

Sun, David C. H.; Roth, Sanford H.; Mitchell, Charles S.; Englund, DeWitt W.

doi:10.1007/bf01255603

Cited by 120 publications

(35 citation statements)

References 15 publications

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“…The incidence of non-ulcer injury may have been low due to the predominant use of radiography rather than endoscopy as a diagnostic tool. Recent reviews and meta-analyses of NSAID gastropathy data in adults, however, confirm preendoscopic estimates, and cross-sectional analyses place the incidence of ulceration between 14% and 31%, with a relative risk for ulceration between 1.9 and 4.7 (6,7,19). The incidence and relative risk estimates for gastroduodenal injury in the present study are consistent with the available evidence in pediatric populations and are supported by numerous studies in adults.…”

Section: Discussionsupporting

confidence: 89%

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

Dowd

Cimaz

Fink

1995

Arthritis & Rheumatism

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Objective. To determine the incidence of abdominal pain and gastroduodenal injury in children with arthritis taking nonsteroidal antiinflammatory drugs (NSAIDs).Methods. A retrospective review of the records of all children (570 patients) receiving followup care in an academic rheumatology clinic between 1991 and 1993 was performed.Results. There were 344 patients who used NSAIDs during the study period. Abdominal pain was recorded in 27.9% of patients taking NSAIDs and 14.6% of patients not taking NSAIDs. Abdominal pain in 47 patients (49%) taking NSAIDs and 14 patients (42%) not taking NSAIDs was evaluated radiographically and/or endoscopically. Among those patients evaluated, gastric or duodenal injury was found in 16 (34.0%) who were taking NSAIDs and 1 (7.1%) who were not. This represented a relative risk for gastroduodenal injury of 4.8 for patients taking NSAIDs (P = 0.09). The incidence of injury did not change when analyses were controlled for prednisone or slow-acting antirheumatic drug use. None of the children were hospitalized or died as a result of gastroduodenal injury during the 3-year period.Conclusion. We conclude that NSAID use in children with arthritis frequently leads to gastroduodenal injury, with an estimated incidence and relative risk that are comparable to the rates found in adults with arthritis taking NSAIDs, but that hospitalization or death as a result of this injury is uncommon. There are no consistent data on the incidence or risk of gastroduodenal injury in pediatric patients taking nonsteroidal antiinflammatory drugs (NSAIDs). It has long been assumed that gastroduodenal injury in children taking NSAIDs is rare. A recent prospective study included 17 NSAID-treated juvenile arthritis patients referred to a gastroenterology clinic for endoscopic evaluation of abdominal pain , hematemesis, stools with occult blood, and/or iron deficiency anemia. A 23% incidence of gastric or duodenal ulcers and a 47% incidence of gastritis or duodenitis was found (1). However, a similar study in which 13 children with rheumatologic conditions who were taking NSAIDs underwent endoscopy for dyspepsia, abdominal pain, or vomiting showed no ulcers and only a single duodenal erosion (2).Risk and incidence figures for gastrointestinal (GI) complications in adults taking NSAIDs vary, depending on the study design and outcome measurements. Meta-analyses and reviews of these data show on average a 3-fold increased risk for severe GI complications (ulcers, GI hemorrhage, perforation, and death) in adults taking NSAIDs, with greater risks for those over the age of 60 (3-10). The incidence of ulceration, as determined by endoscopy, in adults taking NSAIDs ranges from 14% to 31% (4). The cost of managing the GI complications that result from NSAID use in adult arthritis patients was estimated to be 3.9 billion dollars per year in 1988, elevating the cost of treating arthritis by 45% (1 1).In this study, we retrospectively reviewed the records of all patients seen in an academic pediatric rheumatology clinic ov...

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Section: Discussionsupporting

confidence: 89%

Nonsteroidal antiinflammatory drug‐induced gastroduodenal injury in children

Dowd

Cimaz

Fink

1995

Arthritis & Rheumatism

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“…It is well known that NSAIDs induce gastroduodenal ulcers in humans (13,21,23,24,32). Moreover, it was reported recently that NSAIDs induce ulceration in the small intestine and some patients who received NSAIDs chronically died of perforation of the small intestine (1,6,22,28,30).…”

Section: Discussionmentioning

confidence: 99%

Role of Intestinal Bacteria in Ileal Ulcer Formation in Rats Treated with a Nonsteroidal Antiinflammatory Drug

Uejima

Kinouchi

Kataoka

et al. 1996

Microbiology and Immunology

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The role of intestinal bacteria in induction and repression of ulcer formation in the ileum of rats treated with one of the nonsteroidal antiinflammatory drugs (NSAIDs), 5-bromo-2-(4-fluorophenyl)-3-(4-methylsulfonylphenyl) thiophene (BFMeT), was examined in this study. BFMeT was administered by intragastric gavage once at doses of 500-1,500 mg/kg of body weight to Wistar rats treated with and without antibiotics (bacitracin, neomycin, streptomycin), germ-free rats and gnotobiotic rats, and 72 hr later their gastrointestinal tracts were examined for ulcer formation. A single oral administration of BFMeT induced ileal ulcers in specific pathogen-free rats. However, the rats given antibiotics to reduce the intestinal bacteria had no ulcers. BFMeT-treated germ-free rats and gnotobiotic rats mono-associated with Bifidobacterium adolescentis or Lactobacillus acidophilus also had no intestinal ulcers. However, the drug induced ileal ulcers in gnotobiotic rats mono-associated with Eubacterium limosum or Escherichia coli. An overnight culture of B. adolescentis or L. acidophilus or yogurt containing Bifidobacterium breve and Streptococcus thermophilus, when given as drinking water, inhibited ulcer formation in the ileum of rats treated with BFMeT. Gram staining of the ileal contents of normal rats revealed that 97.4% of the stained microorganisms were Gram-positive rods and only 1.2 % were Gram-negative rods. In the group of rats with ulcers induced by BFMeT, the Gram-positive rods decreased by 56.4% and the Gram-negative rods including Escherichia coli, Klebsiella, Proteus and Bacteroides increased by 37.3%. However, in the group of rats administered the Bifidobacterium culture, the Lactobacillus culture or yogurt, the percentages of the Gram-negative rods were decreased. Although Lactobacillus was a major bacterium in the ileum of normal rats, the Gram-negative facultatively anaerobic rods E. coli, Klebsiella and Proteus were increased in the ulcerated ileum of rats treated with BFMeT, suggesting that these bacteria are associated with ulcer formation in rats treated with NSAIDs, and that Lactobacillus and Bifidobacterium inhibit it by repressing the growth of ulcer-inducing bacteria.

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“…Abnor malities of the esophagus were reported by a number of authors, and these were charac terised by dilatation [64] or, more rarely, by stenosis [65,66]. EMD may also be present during this illness [66]. These would include a decrease of the amplitude of the peristaltic contractions in the lower two thirds of the esophagus, very often without any clinical manifestations.…”

Section: Rheumatoid Polyarthritismentioning

confidence: 99%

Section: Rheumatoid Polyarthritismentioning

confidence: 99%

“…These would include a decrease of the amplitude of the peristaltic contractions in the lower two thirds of the esophagus, very often without any clinical manifestations. The high incidence (13-29%) of ulcers during rheumatoid polyar thritis [66][67][68] is probably at least partially linked to the use of therapeutic anti-inflam matory drugs. Involvement of the intestinal mucosa may be observed, if systematically searched for, in 50% or more of cases [69,70].…”

Section: Rheumatoid Polyarthritismentioning

confidence: 99%

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