title: Gastric mucosal injury in systemic lupus erythematosus patients receiving pulse methylprednisolone therapy.
abstract: OBJECTIVE
  Whether glucocorticoids induce gastric mucosal injury remains uncertain. We investigated whether very high-dose steroids caused gastric mucosal injury in systemic lupus erythematous (SLE) patients and evaluated the possible risk factors for mucosal injury.
  
  
  METHODS
  In this prospective paired study, 67 SLE patients who had received pulse methylprednisolone therapy were enrolled. Each patient underwent endoscopic examination and tissue and blood sampling before and after pulse steroid therapy. Mucosal injury was diagnosed if the follow-up injury scale was higher than the initial scale. Examined parameters included Helicobacter pylori infection, cyclooxygenase (COX)-1 and COX-2 activity, and current nonsteroidal anti-inflammatory drug (NSAID) usage including aspirin.
  
  
  RESULTS
  Eleven (16.4%) of 67 cases who developed gastric mucosal injury after pulse therapy had significantly higher rates of peptic ulcer history, NSAID/aspirin use, lower gastric thromboxane B(2) and prostaglandin E(2) levels when compared with cases without gastric mucosal injury (P < 0.05). Infection by H. pylori was not a risk factor for gastric mucosal injury. Multivariate logistic regression analysis showed that NSAID/aspirin use was the only risk factor for gastric mucosal injury in these patients (odds ratio 26.99, 95% confidence interval 4.91, 148.57, P < 0.0001). Pulse steroid therapy alone did not induce gastric mucosal injury in fifty SLE patients without taking any NSAID/aspirin.
  
  
  CONCLUSIONS
  Use of NSAIDs/aspirin, but not H. pylori infection, increases gastric mucosal injury in SLE patients receiving pulse methylprednisolone therapy. Very high-dose steroids de novo seem not to induce gastric mucosal injury in these patients. A larger case-controlled study enrolling a heterogeneous population is needed to clarify the role of glucocorticoids in gastric mucosal injury.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
authors.forename: Jiing-Chyuan
authors.initials: JC
authors.lastname: Luo
authors.forename: Full-Young
authors.initials: FY
authors.lastname: Chang
authors.forename: Tseng-Shing
authors.initials: TS
authors.lastname: Chen
authors.forename: Yee-Yung
authors.initials: YY
authors.lastname: Ng
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Ching-Liang
authors.initials: CL
authors.lastname: Lu
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Chen
authors.forename: Hsiao-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000293:injuries; D016481:Helicobacter Infections / Q000139:chemically induced* / Q000150:complications; D006801:Humans; D008297:Male; D008776:Methylprednisolone Hemisuccinate / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D008776:Methylprednisolone Hemisuccinate; D001241:Aspirin
references.citation: Gastroenterology. 1988 Aug;95(2):327-33
references.pmid: 3260568
references.citation: Gastroenterology. 2000 Sep;119(3):706-14
references.pmid: 10982765
references.citation: N Engl J Med. 1983 Jul 7;309(1):21-4
references.pmid: 6343871
references.citation: Gastroenterology. 1999 Jul;117(1):17-25
references.pmid: 10381905
references.citation: Semin Arthritis Rheum. 1993 Dec;23(3):183-92
references.pmid: 8122121
references.citation: Arthritis Rheum. 1997 Sep;40(9):1725
references.pmid: 9324032
references.citation: Aliment Pharmacol Ther. 2002 Jul;16(7):1241-8
references.pmid: 12144573
references.citation: Arthritis Rheum. 2009 Jan 15;61(1):29-36
references.pmid: 19116963
references.citation: Br J Pharmacol. 2001 Apr;132(7):1565-73
references.pmid: 11264251
references.citation: Clin Pharmacokinet. 2005;44(1):61-98
references.pmid: 15634032
references.citation: Aliment Pharmacol Ther. 2006 Jan 1;23(1):155-67
references.pmid: 16393293
references.citation: Ann Pharmacother. 1995 Feb;29(2):120-4
references.pmid: 7756707
references.citation: Gastroenterology. 2001 Mar;120(4):867-73
references.pmid: 11231941
references.citation: Prostaglandins. 1987 Aug;34(2):311-23
references.pmid: 2823319
references.citation: Gastroenterology. 2000 Aug;119(2):521-35
references.pmid: 10930388
references.citation: Eur J Pharmacol. 2004 Feb 6;485(1-3):275-81
references.pmid: 14757151
references.citation: Semin Arthritis Rheum. 2003 Jun;32(6):370-7
references.pmid: 12833245
references.citation: J Clin Gastroenterol. 1998;27 Suppl 1:S91-6
references.pmid: 9872504
references.citation: J Pharmacol Exp Ther. 2003 Nov;307(2):692-8
references.pmid: 12966148
references.citation: Mol Cell Biochem. 1999 Dec;202(1-2):31-6
references.pmid: 10705992
references.citation: Ann Intern Med. 1991 May 1;114(9):735-40
references.pmid: 2012355
references.citation: N Engl J Med. 1976 Feb 26;294(9):473-9
references.pmid: 173997
references.citation: Am J Med. 1998 Mar 30;104(3A):43S-51S; discussion 79S-80S
references.pmid: 9572320
references.citation: Am J Gastroenterol. 1981 Jan;75(1):17-21
references.pmid: 7234826
references.citation: Lupus. 2008 Jan;17(1):11-5
references.pmid: 18089677
references.citation: Am J Epidemiol. 2001 Jun 1;153(11):1089-93
references.pmid: 11390328
references.citation: Lancet. 2002 Jan 5;359(9300):14-22
references.pmid: 11809181