High-dose ibuprofen therapy associated with esophageal ulceration after pneumonectomy in a patient with cystic fibrosis: a case report.
BACKGROUND
Lung disease in patients with cystic fibrosis is thought to develop as a result of airway inflammation, infection, and obstruction. Pulmonary therapies for cystic fibrosis that reduce airway inflammation include corticosteroids, rhDNase, antibiotics, and high-dose ibuprofen. Despite evidence that high-dose ibuprofen slows the progression of lung disease in patients with cystic fibrosis, many clinicians have chosen not to use this therapy because of concerns regarding potential side effects, especially gastrointestinal bleeding. However, studies have shown a low incidence of gastrointestinal ulceration and bleeding in patients with cystic fibrosis who have been treated with high-dose ibuprofen.


METHODS
The described case illustrates a life-threatening upper gastrointestinal bleed that may have resulted from high-dose ibuprofen therapy in a patient with CF who had undergone a pneumonectomy. Mediastinal shift post-pneumonectomy distorted the patient's esophageal anatomy and may have caused decreased esophageal motility, which led to prolonged contact of the ibuprofen with the esophagus. The concentrated effect of the ibuprofen, as well as its systemic effects, probably contributed to the occurrence of the bleed in this patient.


CONCLUSIONS
This report demonstrates that gastrointestinal tract anatomical abnormalities or dysmotility may be contraindications for therapy with high-dose ibuprofen in patients with cystic fibrosis.
Mackey
Jennifer E
JE
Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, NY, USA. mackeryj@upstate.edu
Anbar
Ran D
RD
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000150:complications; D003131:Combined Modality Therapy; D000075202:Contraindications; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy*; D004935:Esophageal Diseases / Q000139:chemically induced* / Q000209:etiology; D015154:Esophageal Motility Disorders / Q000150:complications; D004942:Esophagitis, Peptic / Q000150:complications; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006547:Hernia / Q000209:etiology; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008171:Lung Diseases / Q000209:etiology; D008297:Male; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000139:chemically induced*; D011458:Prostaglandins E / Q000172:deficiency; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000601:surgery; D014456:Ulcer / Q000139:chemically induced* / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011458:Prostaglandins E; D007052:Ibuprofen