Hepatitis and non-steroidal anti-inflammatory drugs

Article Abstract:

Treatment with non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with hepatotoxicity, toxic effects on the liver, which is a rare, but potentially serious side effect of these agents. All NSAIDs are capable of causing liver damage, but the incidence of NSAID-induced hepatitis, the inflammation of the liver, is not known. Hepatitis resulting from NSAID treatment often resolves when the drug is discontinued. Salicylates were shown to cause hepatitis, usually within four weeks of starting treatment. Salicylate-induced hepatitis commonly affects young women with connective tissue disease, but may also develop with a similar incidence in healthy subjects. Salicylates have been implicated in the development of Reye's syndrome, which is characterized by impaired liver function, decreased blood glucose, increased acidity of body fluids, and brain disease. The early stage of NSAID-induced hepatotoxicity is characterized by fever, rash, discomfort, and upper abdominal pain. Related complications also include an increase in liver enzymes; the infiltration or invasion of liver blood vessels by certain white blood cells, such as eosinophils; liver cell necrosis, or death; and cholestasis, the cessation of bile excretion. Cholestatic hepatitis is characterized by more gradual and delayed onset of symptoms such as a loss of appetite, intense itching, and jaundice. The mechanism of NSAID-induced hepatotoxicity is not known, but may involve a hypersensitivity reaction or the production of toxic metabolic products. In addition to NSAIDs, other factors or conditions may contribute to the development of hepatitis in patients with rheumatic diseases. However, the outcome of NSAID-induced hepatitis is favorable, and symptoms can be treated by discontinuing NSAID therapy. The removal of salicylates from the body can be increased by dialysis, the artificial filtration of the blood. An NSAID agent that causes hepatotoxicity should be substituted with another class of NSAID. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Liver, Hepatitis

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Prophylaxis against non-steroidal induced upper gastrointestinal side effects

Article Abstract:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to reduce inflammation and pain. Examples of NSAIDs include aspirin, diflunisal, naproxen, ibuprofen, piroxicam, suprofen and tolmetin. These drugs are commonly prescribed for the treatment of arthritis. However, NSAIDs can be harmful to the stomach and intestines, and can cause gastrointestinal bleeding. It has been suggested that damage to the small intestine resulting from treatment with NSAIDs may cause diarrhea and iron deficiency in patients with arthritis. A recent study conducted in the United Kingdom reported that out of 156 arthritis patients taking NSAIDs, 63 (40 percent) had stomach or intestinal damage, as determined by endoscopy (a procedure used to examine the gastrointestinal tract), and 13 percent of these patients had active ulcers. Another study reported that the incidence of stomach or intestinal ulcers in patients with arthritis receiving NSAID therapy ranged from 6 to 22 percent and 4 to 8 percent, respectively. The incidence of gastrointestinal ulcers is higher in patients taking NSAIDs than for the general population, where it has been estimated that the incidence of stomach and intestinal ulcers is 0.3 percent and 1.4 percent, respectively. The most common characteristics of gastrointestinal damage caused by NSAIDs are nocturnal pain that can be relieved with antacids, and vomiting and weight loss. Ranitidine and misoprostol have been shown to reduce the incidence of ulcers in patients taking NSAIDs. Also, a new drug called omeprazole has been shown to be a powerful acid suppressant and may be useful for reducing the incidence of ulcers caused by NSAID therapy. It is concluded that the major problem with NSAIDs is that they are so widely prescribed. Ranitidine or misoprostol should be used in combination with NSAIDs when symptoms of stomach or intestinal damage are present, or in patients at high risk for developing ulcers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Risk factors, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Antiulcer agents, Peptic ulcer, Antiulcer drugs

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Experience with misoprostol therapy for NSAID gastropathy in children

Article Abstract:

Misoprostol appears to counteract the adverse gastrointestinal effects of non-steroidal anti-inflammatory drug (NSAID) treatment of rheumatoid diseases in children. Misoprostol is a synthetic analogue of prostaglandin E1. It inhibits flow of stomach acid, increases mucous secretion, which helps protect the stomach lining, and enhances healing of irritated tissues. Twenty-five children ranging in age from 7 to 17 were given misoprostol during NSAID treatment. Of the 88% experiencing stomach pain, nausea, vomiting, or bloating, 82% had complete resolution of symptoms and a further 9% showed improvement. Hemoglobin levels rose even in patients who were not anemic, which suggests that minor injuries contributing to blood loss had healed. One patient experienced diarrhea, which resolved on its own without need to discontinue misoprostol treatment.

Physiological aspects, Gastrointestinal system

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