Nonsteroidal anti-inflammatory drugs and peptic ulcer disease
Article Abstract:
Nonsteroidal, anti-inflammatory drugs (NSAIDs) are pain relievers known to increase the incidence of ulcer disease in the patients using them. Ordinarily, the cells and tissues of the stomach are resistant to injury induced by acids and toxins, such as alcohol and aspirin. The mechanisms of this resistance include the production of both bicarbonate to neutralize the acid and mucus to provide a protective layer over the cells. The cells that are destroyed or injured are generally replaced. Other substances in the body with a protective value are prostaglandins, which probably act by several different mechanisms. NSAIDs appear to cause damage to the stomach in two ways, both by direct irritation and by being absorbed into the bloodstream. Once in the bloodstream, NSAIDs inhibit the formation of prostaglandins. Attempting to clarify and possibly differentiate NSAID-induced ulcers from those produced in other ways has proven difficult, as little consensus exists on just which abnormal stomach lesions represent true ulcers. Patients' symptoms are not predictive of NSAID-induced ulcer risk, as up to 60 percent of these ulcers may bleed or perforate (burst) without antecedent ulcer pain. The elderly seem to be more vulnerable to painless but complicated ulcer disease. Most of the studies to date on NSAID-induced ulcer disease are flawed in some way. Treatment for NSAID-induced ulcer disease varies. Omeprazole, an inhibitor of stomach acid production, appears to aid in healing ulcers, even when NSAID therapy continues, although it has not received FDA (Food and Drug Administration) approval for that use. Another category of drugs with some ability to treat ulcers caused by NSAIDs is known as H-2 blockers. Misoprostol, a new agent that is an analog of one of the protective prostaglandins, has been shown to help somewhat in preventing ulcers caused by NSAIDs. The first-line treatment for NSAID-induced ulcer disease would certainly be stopping the drug, whenever possible. Concomitant use of an H-2 blocker or omeprazole might be prudent in those patients for whom NSAIDs are necessary. Further well-controlled studies with large numbers of patients and controls are warranted. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1991
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No association between calcium channel blocker use and confirmed bleeding peptic ulcer disease
Article Abstract:
Calcium channel antagonists have been reported to be associated with increased incidence of gastrointestinal bleeding. A retrospective cohort study of people in the Tennessee Medicaid program and aged 65 or older, 1984-86, was carried out. After controlling for important confounders, there was no greater risk of hospitalization for bleeding peptic ulcer for those who used calcium channel blockers or beta blockers.
Publication Name: American Journal of Epidemiology
Subject: Health
ISSN: 0002-9262
Year: 1998
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