[Treatment of peptic ulcer related to rheumatic diseases].
Rheumatic diseases often have gastrointestinal(GI) manifestations, and may present as GI bleeding and perforation due to peptic ulcer associated with high mortality. Major causes of peptic ulcer related to rheumatic diseases are drugs such as nonsteroidal anti-inflammatory drug(NSAID) and corticosteroid, and vasculitis. The analgesic effects of NSAID often mask abdominal pain until they cause GI bleeding and perforation. Therefore, it is important to make early diagnosis of peptic ulcer with upper gastrointestinal endoscope. Fundamental treatment of NSAID induced peptic ulcer is to quit it, however it is difficult because of activity of rheumatic diseases. Also, most NSAID induced peptic ulcers heal by administration of proton pump inhibitor or misoprostol. Corticosteroid pulse therapy or administration of immunosuppressant agents is effective for vasculitis induced peptic ulcer, however it is difficult to make diagnosis of it. Development of NSAID with less side effects such as cyclooxygenase-2 selective inhibitors and establishment of diagnosis and treatment of peptic ulcer related to rheumatic diseases are expected.
Center for Diagnostic and Therapeutic Endoscopy, Keio University Hospital.
Hiroyuki
H
Imaeda
Hiromasa
H
Ishii
Makoto
M
Goto
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D016595:Misoprostol / Q000627:therapeutic use; D009853:Omeprazole / Q000627:therapeutic use; D010437:Peptic Ulcer / Q000209:etiology* / Q000628:therapy; D010488:Polyarteritis Nodosa / Q000150:complications; D054328:Proton Pump Inhibitors; D012216:Rheumatic Diseases / Q000150:complications*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D016595:Misoprostol; D009853:Omeprazole