Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.
Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use.
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关节炎患者长期使用非甾体抗炎药期间的胃十二指肠粘膜和消化不良症状。
DOI：
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发表时间：
1987
影响因子：
9.8
通讯作者：
David Y. Graham
中科院分区：
文献类型：
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作者：
E. Larkai;J. L. Smith;M. Lidsky;David Y. Graham
胃十二指肠不耐受是限制关节炎患者使用阿司匹林和其他非甾体抗炎药 (NSAID) 的主要因素之一。我们评估了 65 名患者（63 名男性和 2 名女性）长期每日服用非甾体抗炎药治疗骨关节炎或类风湿关节炎的胃十二指肠粘膜的内窥镜外观。连续服用八种不同的药物（吲哚美辛、布洛芬、萘普生、舒林酸、吡罗昔康、阿司匹林、水杨酸和托美汀）至少 6 周。七名患者服用了两种不同的非甾体抗炎药。没有使用其他已知会损害粘膜的药物。 21 名患者（32%）内镜下胃和十二指肠完全正常，44 名患者（68%）有损伤证据（粘膜出血 44.6%，糜烂 53.8%，粘膜出血和糜烂 34%）。 10 名患者检测到溃疡（7 名胃溃疡、2 名幽门通道溃疡、1 名十二指肠球部溃疡），点患病率为 15.4%。在单独服用萘普生、吲哚美辛、托美丁、舒林酸和布洛芬或与阿司匹林联合服用的患者中发现了溃疡。内镜检查完全正常的患者中有 19% 出现消化不良症状，内镜检查结果异常的患者中只有 9% 出现消化不良症状。 10名溃疡患者中只有3人出现消化不良症状。药物引起胃十二指肠损伤的倾向没有显着差异。我们证实，无症状的类风湿和骨关节炎患者会出现相当严重的胃十二指肠损伤，并且症状并不能预示损伤的存在。
Gastroduodenal intolerance is one of the major factors limiting the use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAID) in patients with arthritic conditions. We evaluated the endoscopic appearance of the gastroduodenal mucosa in 65 patients (63 men and two women) taking regular daily doses of NSAIDs over a long period for osteoarthritis or rheumatoid arthritis. Eight different drugs (indomethacin, ibuprofen, naproxen, sulindac, piroxicam, aspirin, salsalate, and tolmetin) had been taken continuously for at least 6 wk. Seven patients took two different NSAIDs. No other drug known to damage the mucosa was used. Twenty-one patients (32%) had an endoscopically completely normal stomach and duodenum, and 44 (68%) had evidence of injury (mucosal hemorrhage 44.6%, erosions 53.8%, both mucosal hemorrhage and erosions 34%). Ten patients had ulcers detected (seven gastric, two pyloric channel, one duodenal bulb) for a point prevalence of 15.4%. Ulcers were found in patients taking naproxen, indomethacin, tolmetin, sulindac, and ibuprofen, either alone, or in combination with aspirin. Dyspeptic symptoms were present in 19% of those with completely normal endoscopy and in only 9% of those with abnormal endoscopic findings. Only three of the 10 patients with ulcer had dyspeptic symptoms. There was no significant difference between drugs in tendency to cause gastroduodenal injury. We confirm that fairly severe gastroduodenal injury occurs in asymptomatic patients with rheumatoid and osteoarthritis, and that symptoms do not predict the presence of damage.