[Application of quantifying scoring systems for the determination of changes in the mucosa of the upper gastrointestinal tract. A comparative study of a diclofenac effervescent tablet with conventional diclofenac preparations and acetylsalicylic acid after repeated administration].
Application of Quantifying Scoring Systems for the Determination of Changes of the Mucosa of the Upper Gastrointestinal Tract/A comparative study of a diclofenac effervescent tablet with conventional diclofenac preparations and acetylsalicylic acid after repeated administration.


OBJECTIVE
A new diclofenac effervescent tablet (DIC-BT) was developed in order to circumvent the high variable delay in delivery of the drug in enteric coated tablets of diclofenac (CAS 15307-86-5). The gastrointestinal side effects of the effervescent tablet were investigated in comparison to two other galenic principles of DIC preparations (DIC entero coated dragees = DIC-mrD) and dispersible tablets (DIC-DispT) and to acetylic salicylic acid (ASA (CAS 50-78-2). For the assessment of gastrointestinal side effects, two score systems were used simultaneously. The Lanza-scores were compared with our HEU-criteria system (Haemorrhage, Erosion, Ulceration) to find out if the pattern and the localisation of the lesions differ between the drugs tested.


METHODS
In a single-blind, randomised, controlled, parallel study design healthy volunteers (27 females, 33 males; mean age 26.9 years, mean b.w. 72.5 kg, Helicobacter pylori antibody negative) were treated by 150 mg/d DIC or 1500 mg ASA (as positive control group) for 7 days. DIC-BT (n = 20 subjects), DIC enteric coated dragees (DIC-mrD) (n = 20), DIC-Dispers tablets (DIC-DispT) (n = 10) and ASA (n = 10) were administered t.i.d. The effects were investigated by videoendoscopy with chromoscopy before and after treatment. Mucosa lesions were assessed according to the Lanza-scores and HEU-criteria system. The results were calculated as pre-post comparison and assessed as paired test between treatment groups.


RESULTS
DIC preparations caused mostly erosions and scarcely haemorrhages, but different from ASA only few combined lesions of haemorrhages and lesions in Corpus ventriculi and Bulbus duodeni. The number of mucosal lesions was different with regard to the region (Antrum ventriculi > Corpus ventriculi > Bulbus duodeni). The spreading with Helicobacter pylori (histological assessment at the end of study) varied between 20% and 50% (7/20 subjects in DIC-BT and DIC-msrD, respectively, 5/10 in DIC-dispT group, 2/10 subjects in the ASA group). Based on the HEU-criteria, erosions were seen in 9/20 subjects in DIC-BT, 10/20 subjects in DIC-mrD, 4/10 in DIC-DispT, and 3/10 subjects in ASA group, respectively, the combination of haemorrhages and erosions is seen in 2/20 subjects in DIC-BT, 6/20 in DIC-mrD, 4/10 subjects in DIC-DispT, and in 7/10 subjects in the ASA group, respectively. The difference is significantly between DIC-BT and ASA (p < 0.05) to the sum of all lesions in stomach. Based on Lanza-scores (score values > 2), (a) erosions were seen in 7/20 subjects in DIC-BT, 15/20 subjects in DIC-mrD, 7/10 in DIC-DispT, and 9/10 subjects in ASA group; (b) haemorrhages were seen in 0/20 subjects in DIC-BT, 5/20 subjects in DIC-mrD, 2/10 in DIC-DispT, and 4/10 subjects in ASA group, (c) combined type in 3/20 subjects in DIC-BT, 8/20 subjects in DIC-mrD, 5/10 in DIC-DispT, and 8/10 subjects in ASA group, respectively. Independent of the scoring systems, the difference was significant between DIC-BT and DIC-mrD, as well as between all DIC preparations and ASA. At the end of the study Helicobacter pylori infections were observed by biopsy in 20-50% of volunteers (DIC-BT and DIC-mrD in 7/20 subjects, each, and DIC-DispT in 5/10, and ASA in 2/10 subjects, respectively) and between Dic-BT and ASA (p < 0.05) for all categories.


CONCLUSIONS
Mucosal lesions induced by DIC-BT were significantly less than by DIC-mrD and DIC-DispT. The effect was confirmed by both scoring systems, i.e. Lanza scores and HEU-criteria system. Using the HEU-criteria the pattern and the localization of the lesions could be characterized. There were remarkable differences between the effects of DIC and ASA. The assessment of gastrointestinal side effects using the HEU-criteria was superior to Lanza-scores because there was no bias according to the type of lesion and the type of drug.
Wildgrube
Hans Jörg
HJ
Institute for Applied Diagnostic International (IAD International Ltd.), Mahone Bay, Nova Scotia, Canada.
Kierschke
Gerd
G
Nowak
Horst
H
Weigmann
Ingo
I
Terhaag
Bernd
B
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects*; D004338:Drug Combinations; D004724:Endoscopy; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000473:pathology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D010437:Peptic Ulcer / Q000139:chemically induced / Q000473:pathology; D016037:Single-Blind Method
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D004008:Diclofenac; D001241:Aspirin