title: Acute NSAID-related transmural duodenitis and extensive duodenal ulceration.
abstract: BACKGROUND
  A 40-year-old previously healthy white man presented to the emergency department at American University of Beirut Medical Center, Beirut, Lebanon, with severe upper abdominal pain of 36-hour duration. The pain started a few hours after the intake of a single tablet of tiaprofenic acid and became more intense after the intake of another tablet 24 hours later. He had no other symptoms. He had no prior upper gastrointestinal (GI) symptoms, ulcer disease, steroidal or nonsteroidal anti-inflammatory drug use, or ethanol intake. Physical examination revealed mild upper abdominal tenderness. Complete blood count, amylase, lipase, and liver function tests were unremarkable. Computed tomography of the abdomen showed marked thickening of the duodenal wall with surrounding mesenteric streaking. Upper GI endoscopy revealed extensive ulceration involving the duodenal bulb, apex, and proximal D2, as well as a few gastric erosions. Histopathologic examination of duodenal biopsy samples showed extensive epithelial cell necrosis and infiltration of the lamina propria with neutrophils and eosinophils. The patient responded well to rabeprazole 20 mg BID and remains well 5 months later.
  
  
  METHODS
  We performed a literature search of PubMed for all English-language articles published between January 1970 and present (June 2007) using the key words tiaprofenic acid, nonsteroidal anti-inflammatory drugs, NSAID, duodenitis, duodenal erosion, duodenal ulcer, gastritis, gastric erosion, gastric ulcer, or peptic ulcer. We reviewed all randomized controlled trials involving NSAIDs found using PubMed, with a focus on their GI adverse effects.
  
  
  RESULTS
  Based on the PubMed search, there were no published reports of acute transmural duodenitis and complicated duodenal ulcers associated with short-term exposure to tiaprofenic acid or other NSAIDs. The Naranjo adverse drug reaction (ADR) probability scale was used and a score of 6 was obtained, indicating a probable ADR from tiaprofenic acid use.
  
  
  CONCLUSIONS
  We report a patient who developed symptomatic severe transmural duodenitis and periduodenal mesenteric streaking, consistent with a complicated ulcer, probably associated with very short-term exposure to tiaprofenic acid.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Jana G
authors.initials: JG
authors.lastname: Hashash
authors.forename: Lamya A
authors.initials: LA
authors.lastname: Atweh
authors.forename: Teddy
authors.initials: T
authors.lastname: Saliba
authors.forename: Zaher
authors.initials: Z
authors.lastname: Chakhachiro
authors.forename: Aghiad
authors.initials: A
authors.lastname: Al-Kutoubi
authors.forename: Ayman
authors.initials: A
authors.lastname: Tawil
authors.forename: Kassem A
authors.initials: KA
authors.lastname: Barada
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000473:pathology; D004382:Duodenitis / Q000139:chemically induced* / Q000473:pathology; D004724:Endoscopy; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D009504:Neutrophils / Q000473:pathology; D011422:Propionates / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014098:Toothache / Q000188:drug therapy
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D011422:Propionates; C021270:tiaprofenic acid