[NSAIDs induced gastroduodenal ulcer in the aged].
The main drugs causing gastroduodenal ulcers are NSAIDs, steroids, antibiotics and anticancer agents. Among these causative drugs, nonsteroidal antiinflammatory drugs (NSAIDs) ranked first, followed by steroids, antibiotics, anticancer agents and other drugs, including over the counter drugs for the management of pain and common cold. Mechanisms of mucosal injury of NSAIDs are mainly direct inhibition cyclooxygenase (COX), mucosal injury by free radicals and direct contact of a drug to mucosa according to high acidity and high osmotic pressure. Clinical features of NSAIDs induced gastric ulcers are below: ulcer location concentrated in the pyloric region to the antrum, comprising three-fourths of all cases, multiple ulcers are found in 24% of the subjects. The frequency of relatively small ulcers, surrounded by highly swollen mucosa, is high. Deeply dug ulcers and large, irregularly shaped ulcers are also characteristic findings. NSAIDs induced bleeding gastroduodenal ulcers are seen in 21% of bleeding gastric ulcers which are stopped by the hemostatic method using pure ethanol injection. More than 80% of the cases are in the aged. All cases are successfully stopped bleeding and treated conservatively.
Division of Gastroenterology, Tohoku University School of Medicine.
Shigeru
S
Asaki
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000431:Ethanol / Q000008:administration & dosage; D016558:Hemostasis, Endoscopic; D006801:Humans; D015552:Injections, Intralesional; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000628:therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000431:Ethanol