Abstract
Adverse effects of drugs, particulariy of nonsteroidal anti-inflammatory drugs (NSAIDs), on upper gastrointestinal tract injury are significant. Gastrointestinal symptoms, particulariy nausea, anorexia, abdominal pain and dyspepsía, are found in as much as one-third of patients as adverse reactions of medications.
Antibiotics and nonsteroidal anti-inflammatory drugs are reported to be the most common drugs to cause adverse events. Clinically, oesophageal changes present as retrosternal pain and odynophagia.
Oesophageal lesions are either temporary or permanent with strictures. Injury to the oesophageal mucosa may be induced by drugs with a local effect or by reducing lower oesophageal sphincter tone and, thus, allowing gastro-oesophageal reflux.
Injury to the gastric mucosa caused by NSAIDs presupposes a reduction in mucosal prostaglandins that act as mucosal protection. Injury may occur with any route of administration of NSAIDs, i.e. oral, rectal as well as parenteral.
When detected on endoscopy, NSAID gastropathy presents as erythema, petechiae, aphthae, erosions, haemorrhagic gastropathy and ulcers. The risk of manifestation of gastric and duodenal ulcer disease is increased by as much as tenfold with the use of NSAIDs.
The peak incidence occurs in the first three months of treatment; however, it may be manifested at any time during the treatment with NSAIDs. Patients with risk factors should simultaneously receive proton pump inhibitors or can only be given coxibs.
Patients with previous gastrointestinal bleeding or those who take anticoagulants and require NSAIDs should receive coxibs in combination with proton pump inhibitors and should be screened for the presence of infection with Helicobacter pylori.