Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent.
OBJECTIVE
To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics.


METHODS
The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group I) with suicidal intent. Thirty patients with or without mild complaints of dyspepsia (group II) were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score (LS), expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis.


RESULTS
Gastroduodenal damage was signifi-cantly more severe in group I compared to group II (P < 0.01). The LS was similar in both groups Ia and Ib. However LS was significantly higher in patients who had ingested multiple NSAIDs (group Ic) compared to other patients (P < 0.01). The LS was correlated to age (P < 0.01) and total amount of drug ingested (P < 0.05) in group I; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P > 0.05). The biopsy score (BS) was higher in group I than group II (P < 0.01), and higher in group Ib than group Ia (P < 0.05).


CONCLUSIONS
The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of high-dose acetaminophen.
Soylu
Aliye
A
Gastroenterology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Nezihi Ozmen Mahallesi 6.Gokler Sitesi A. 5 Blok, D:9 Merter, Istanbul 34147, Turkey. aliyesoylu@superonline.com
Dolapcioglu
Can
C
Dolay
Kemal
K
Ciltas
Aydin
A
Yasar
Nurgul
N
Kalayci
Mustafa
M
Alis
Halil
H
Sever
Nurten
N
D000082:Acetaminophen / Q000009:adverse effects*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D001706:Biopsy; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal; D005756:Gastritis / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology; D013406:Suicide, Attempted; D055815:Young Adult
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen