Interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs in cirrhotic patients with bleeding esophagogastric varices.
OBJECTIVE
Bleeding from esophagogastric varices is a life-threatening complication of chronic liver disease. As compared with esophageal varices (EV), the risk factors for bleeding from gastric varices remain unclear. This study examined interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs (NSAIDs) as related to bleeding esophagogastric varices in cirrhotic patients.


METHODS
Eighty-eight cirrhotic patients with an initial episode of bleeding esophagogastric varices who had not received prior treatment studied. The patients were divided 3 groups: 58 with bleeding from EV, 13 with bleeding from cardiac varices (CV), and 17 with bleeding from cardiofundic or fundic varices (FV). The use of "standard" NSAIDs on 4 or more of the last 7 days before the initial episode of bleeding was defined as "regular" use; all other use was considered "occasional".


RESULTS
The number of anti-ulcer drug users was 16 (27.6%) in the EV group, 4 (30.8%) in the CV group, and 5 (29.4%) in the FV group. The number of NSAID users was 9 (15.5%) in the EV group, 4 (30.8%) in the CV group, and 11 (64.7%) in the FV group. The proportion of NSAID users was significantly higher in the FV group than in the EV group (p < 0.0001). All 16 users of anti-ulcer drugs who were nonusers of NSAIDs had varices with red color signs. All NSAID users had used NSAIDs orally within a day before the initial episode of bleeding. All "regular" NSAID users were nonusers of anti-ulcer drugs. All anti-ulcer drug users without red color signs were "occasional" NSAID users.


CONCLUSIONS
"Occasional" oral NSAID use is an important step leading to variceal hemorrhage, especially in FV, even if the mucosa is protected by anti-ulcer drugs. The ability to use NSAIDs for several days without variceal bleeding in some patients with esophagogastric varices who are concurrently receiving anti-ulcer drugs suggests that such drugs might protect the esophagogastric mucosa.
Yoshida
Hiroshi
H
Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. hiroshiy@nms.ac.jp
Mamada
Yasuhiro
Y
Taniai
Nobuhiko
N
Mineta
Sho
S
Kawano
Youichi
Y
Mizuguchi
Yoshiaki
Y
Kakinuma
Daisuke
D
Kanda
Tomohiro
T
Tajiri
Takashi
T
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000494:pharmacology*; D004347:Drug Interactions; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents