A comparison of upper gastrointestinal mucosal damage by standard and delayed-release indomethacin.
Forty-five patients taking long-term indomethacin and with endoscopic erosions or superficial ulcers in the oesophagus, stomach or duodenal bulb were randomized in a double-blind study to continue with standard indomethacin or receive a 'delayed-release' formulation. This consisted of microgranules of indomethacin coated with an acrylic resin, Eudragit L, which releases drug in the small intestine. Endoscopy was repeated after 8 weeks and biopsies taken on both occasions. Changes in endoscopic lesions and histological appearances were similar in both groups, although mucosal erythema was less in those given Eudragit L indomethacin. Systemic, rather than topical, effects of indomethacin may therefore be responsible for persistence of gastro-duodenal mucosal lesions in these patients. There is reason to question the clinical practice of using expensive, delayed-release preparations.
Swift
G L
GL
Department of Gastroenterology, University Hospital of Wales, Cardiff, UK.
Arnold
J
J
Williams
G T
GT
Williams
B D
BD
Rhodes
J
J
Khan
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004381:Duodenal Ulcer / Q000139:chemically induced; D004382:Duodenitis / Q000139:chemically induced; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000139:chemically induced; D004947:Esophagus / Q000187:drug effects; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects*; D005756:Gastritis / Q000139:chemically induced; D005767:Gastrointestinal Diseases / Q000139:chemically induced*; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage* / Q000009:adverse effects*; D007413:Intestinal Mucosa / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D011109:Polymethacrylic Acids / Q000008:administration & dosage; D013276:Stomach Ulcer / Q000139:chemically induced
D003692:Delayed-Action Preparations; D011109:Polymethacrylic Acids; C038300:methylmethacrylate-methacrylic acid copolymer; D007213:Indomethacin