misoprostol and Abdominal-Pain

There is great controversy regarding the most effective route for cervical priming before diagnostic or operative hysteroscopy.. To evaluate the evidence from published randomized clinical trials (RCTs) about the efficacy and safety of oral vs vaginal misoprostol for cervical priming before hysteroscopy.. Electronic databases including PubMed, Cochrane Library, Scopus and Web of Science were searched using the relevant keywords.. All RCTs assessing the effect of oral vs vaginal misoprostol before hysteroscopy for cervical priming were considered. One hundred and ten studies were identified, of which eight studies were deemed eligible for this review.. The extracted outcomes were: cervical canal width, ease of dilatation, time for cervical dilatation and adverse effects (nausea, vomiting, diarrhoea, bleeding, fever, abdominal pain/uterine cramping and any complications during the procedure). All statistical analyses were completed using RevMan.. Eight RCTs with 768 patients were included in this meta-analysis. Cervical canal width did not differ significantly between the two routes of misoprostol administration [mean difference -0.25 mm, 95% confidence interval (CI) -0.92-0.42; p = 0.47]. However, the vaginal route was significantly superior to the oral route for reducing the time for cervical dilatation (standardized mean difference 0.17, 95% CI 0.02-0.32; p = 0.03). No significant differences in adverse effects were found between the routes, except for diarrhoea which was significantly less prevalent with vaginal administration of misoprostol (risk ratio 2.48, 95% CI 1.17-5.26; p = 0.02).. Oral and vaginal administration of misoprostol before hysteroscopy were similar in terms of cervical canal width, ease of dilatation and various adverse effects, except that the vaginal route was associated with faster cervical dilatation and lower prevalence of diarrhoea.

Topics: Abdominal Pain; Administration, Intravaginal; Administration, Oral; Cervix Uteri; Diarrhea; Dilatation; Female; Humans; Hysteroscopy; Misoprostol; Oxytocics; Premedication; Randomized Controlled Trials as Topic

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Therapeutic; Administration, Intravaginal; Administration, Oral; Adult; Drug Therapy, Combination; Female; Fetal Diseases; Hernia, Umbilical; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Ultrasonography; Uterine Rupture

Does repeat administration of misoprostol for early pregnancy loss increase the treatment success rate?. Repeat administration of misoprostol does not increase the treatment success rate, and is associated with more analgesics use.. Misoprostol reduces the need for surgical evacuation and shortens the time to complete expulsion in patients with early pregnancy loss. However, the impact of repeat doses of misoprostol is not clear.. A randomized clinical trial was conducted in a single tertiary hospital, recruiting women with early pregnancy loss (<12 weeks), seeking medical treatment, between August 2015 and June 2016. A sample size of 160 patients was sufficient to detect a 30% decrease in treatment success.. Participants received 800 μg of misoprostol vaginally on Day 1, and were then randomly assigned into two groups: Patients in the single-dose group were evaluated on Day 8. Patients in the repeat-dose group were evaluated on Day 4, when they were given a repeat dose if required, and scheduled for re-evaluation on Day 8. If complete expulsion was not achieved on Day 8 (endometrial thickness >15 mm or the presence of gestational sac on transvaginal sonography), participants underwent surgical evacuation. The primary outcome was treatment success, defined as no need for surgical intervention up to Day 8.. Final analysis included 87 participants in the single-dose group and 84 participants in the repeat-dose group, out of whom 41 (48.8%) received a second dose. Treatment succeeded in 67 (77%) patients in the single-dose group and 64 (76%) patients in the repeat-dose group (RR 0.98; 95% CI 0.83-1.16; P = 0.89). Patients in the repeat-dose group reported more use of over the counter analgesics (82.1% versus 69.0%, P = 0.04).. The study was not blinded and our definition of complete expulsion may be debated. Follow-up time was not equal in all participants, since some had a complete expulsion on Day 4 and some underwent emergent D&C before Day 8. This, however, should not affect the primary outcome.. Our results suggest that a single-dose protocol is superior to a repeat-dose protocol due to a comparable success rate and more favorable outcomes regarding the need for analgesic drugs.. We did not receive funding for this study and we declare no conflict of interest.. ClinicalTrials.gov (NCT02515604).. 2 August 2015.. 19 August 2015.

Topics: Abdominal Pain; Abortion, Incomplete; Abortion, Spontaneous; Academic Medical Centers; Adult; Analgesics; Combined Modality Therapy; Dose-Response Relationship, Drug; Embryo Loss; Female; Follow-Up Studies; Humans; Intention to Treat Analysis; Israel; Lost to Follow-Up; Misoprostol; Oxytocics; Patient Dropouts; Pregnancy; Tertiary Care Centers; Ultrasonography; Vacuum Curettage

Dysregulated cytokine metabolism plays a critical role in the pathogenesis of many forms of liver disease, including alcoholic and non-alcoholic liver disease. In this study we examined the efficacy of Misoprostol in modulating LPS-inducible TNFα and IL-10 expression in healthy human subjects and evaluated molecular mechanisms for Misoprostol modulation of cytokines in vitro. Healthy subjects were given 14day courses of Misoprostol at doses of 100, 200, and 300μg four times a day, in random order. Baseline and LPS-inducible cytokine levels were examined ex vivo in whole blood at the beginning and the end of the study. Additionally, in vitro studies were performed using primary human PBMCs and the murine macrophage cell line, RAW 264.7, to investigate underlying mechanisms of misoprostol on cytokine production. Administration of Misoprostol reduced LPS inducible TNF production by 29%, while increasing IL-10 production by 79% in human subjects with no significant dose effect on ex vivo cytokine activity; In vitro, the effect of Misoprostol was largely mediated by increased cAMP levels and consequent changes in CRE and NFκB activity, which are critical for regulating IL-10 and TNF expression. Additionally, chromatin immunoprecipitation (ChIP) studies demonstrated that Misoprostol treatment led to changes in transcription factor and RNA Polymerase II binding, resulting in changes in mRNA levels. In summary, Misoprostol was effective at beneficially modulating TNF and IL-10 levels both in vivo and in vitro; these studies suggest a potential rationale for Misoprostol use in ALD, NASH and other liver diseases where inflammation plays an etiologic role.

Topics: Abdominal Pain; Animals; Anti-Ulcer Agents; Cell Line; Cells, Cultured; Cyclic AMP; Cytokines; Diarrhea; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Gene Expression; Humans; Interleukin-10; Leukocytes, Mononuclear; Lipopolysaccharides; Liver Diseases; Macrophages; Male; Mice; Misoprostol; Nausea; Signal Transduction; Tumor Necrosis Factor-alpha

To explore the lowest effective dosage of mifepristone combined with misoprostol in terminating ultra-early pregnancy.. All the cases of ultra-early pregnancy classified by amenorrhea days, β-hCG and vaginal B-ultrasonic were randomly divided into two groups. One hundred cases in G1 group (minimized dosage) were orally administered 25 mg mifepristone once a day for 2 days and combined with 200 µg misoprostol 48 hours later, while 150 mg mifepristone combined with 600 µg misoprostol 48 hours later were given to 100 cases in G2 group (normal dosage). All cases were observed for 6 hours after taking misoprostol and returned for assessment three days later.. None missing. Expulsion of conceptus: G1 and G2 group were 22 (22.0%, 22/100) and 25 (25.0%, 25/100; P > 0.05). Failure rate: cases with incomplete abortion were 1 (1.0%, 1/100) and 2 (2.0%, 2/100) in G1 and G2 group, hospitalization for suspected ectopic pregnancies both was 1 (1.0%). Bleeding: bleeding cases during the administration of mifepristone in G1 and G2 group were 71 (71.0%, 71/100) and 78 (78.0%, 78/100; P > 0.05); the mean bleeding time were (5.3 ± 1.4) days and (6.0 ± 1.5) days (P < 0.01). Other side effects: in G1 group, majority showed light nausea (7.0%, 7/100) and light abdominal pain (20.0%, 20/100). Menses recovery: 99 (99.0%, 99/100) for G1 group and 98 (98.0%, 98/100) for G2 group to recovery on scheduled time. Satisfactions: both were 99 (99.0%, 99/100). Except mean bleeding days and side-effects, the differences above showed no significance (P > 0.05).. It is safe and effective treatment with the lowest dosages of mifepristone and misoprostol to terminate ultra-early pregnancies.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Administration, Oral; Adult; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Mifepristone; Misoprostol; Nausea; Patient Satisfaction; Pregnancy; Treatment Outcome; Uterine Hemorrhage; Young Adult

Medical abortion regimens based on the use of either misoprostol alone or in association with mifepristone have shown high efficacy and excellent safety profile in early pregnancy abortion. However, no clear recommendation is available for late first-trimester termination of pregnancy.. A prospective randomized controlled trial included 122 women seeking medical abortion at 9 to 12 weeks of gestation. Seventy-three patients were given a fixed protocol of 200 mg of mifepristone followed 48 h later by 400 mcg oral misoprostol (Group 1). The second group of 49 patients was administered 800-mcg intravaginal single-dose misoprostol (Group 2). This study sought to compare safety, efficacy and acceptability of these two nonsurgical abortion regimens.. Fifty-nine (80.8%) women in Group 1 had complete abortion vs. 38 (77.4%) women in Group 2 (p=.66). Abdominal pain was observed significantly more often in Group 2 (35/49 (71.4%) vs. 32/73 (43.8%) in Group 1, p<.0001. Medical abortion was equally acceptable among the two groups [37/49 (75.5%) and 55/73 (75.7%), p=.89].. For late first-trimester termination, a single 800-mcg vaginal dose of misoprostol seems to be as effective as the mifepristone+misoprostol regimen, with acceptable side effects.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Female; Humans; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Young Adult

Because seminal prostaglandins play a role at natural fertilization, it was hypothesized that vaginal supplementation of prostaglandins at the time of intrauterine insemination (IUI) might enhance chances of conception. We investigated the effect of misoprostol, a prostaglandin analogue, on the success rate of IUI.. A multi-center double-blind randomized controlled trial, using a cross-over design with alternating sequence, was designed. Vaginal tablets of misoprostol or placebo were used in conjunction to intrauterine insemination. In total, 199 women, comprising 466 cycles, were analyzed. Main outcome measures were pregnancy rate and prevalence of vaginal bleeding and uterine cramps.. The misoprostol group accounted for 146 cycles with 19 pregnancies, whereas the placebo group cycles totaled 164 cycles with 21 pregnancies (13.0 vs. 12.8%, not significant). There was a statistically significant increase in vaginal bleeding (12.3 vs. 1.8%; OR 7.55; 95% CI 2.31-24.48) and abdominal cramping rates (15.1 vs. 4.3%; OR 3.98; 95% CI 1.68-9.39) after application of misoprostol. Due to these severe adverse events the study was prematurely terminated.. Although prostaglandins surely play a role in natural human reproduction, vaginal administration of misoprostol at the time of IUI is associated with a high rate of side effects and does not seem to enhance the outcome.

Topics: Abdominal Pain; Administration, Intravaginal; Adult; Cross-Over Studies; Double-Blind Method; Female; Humans; Insemination, Artificial; Male; Misoprostol; Pregnancy; Prospective Studies; Prostaglandins, Synthetic; Uterine Hemorrhage; Young Adult

Vaginal administration of prostaglandin analogues as well as nitric oxide donors before first-trimester surgical abortion has been shown to induce effective cervical ripening. In addition, nitric oxide donors, such as isosorbide mononitrate and nitroglycerin, have been associated with a patient-friendly side-effect profile when administered 3 h before the surgical procedure. We wanted to compare the cervical ripening effect and possible side effects of isosorbide mononitrate and the prostaglandin analogue misoprostol when self-administered at bedtime the evening before surgical abortion.. One hundred and twenty nulliparous women scheduled for suction termination of pregnancy in the first trimester were randomly assigned to receive per vaginam either 40 mg of isosorbide mononitrate or 200 microg of misoprostol. Sixty of the women were included for assessment of cervical ripening as well as evaluation of side effects. The other 60 women were recruited for assessment of side effects only. Cervical ripening was evaluated by measuring baseline cervical dilation and the cumulative force to dilate the cervix to 9 mm by means of a cervical tonometer. For assessment of side effects, the women were asked to complete a symptom questionnaire.. Cervical resistance was significantly higher in women treated with isosorbide mononitrate compared to misoprostol (median cumulative force 73 versus 15 N). Common side effects of misoprostol were abdominal pain (69%), nausea (44%), and vaginal bleeding (66%), while in the isosorbide mononitrate group headache was frequently experienced (79%). In both treatment groups, the frequency and intensity of side effects gradually increased during the treatment interval.. Misoprostol induced a more pronounced cervical ripening than isosorbide mononitrate, but both regimens were associated with a high frequency of side effects.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Adolescent; Adult; Ambulatory Care; Cervical Ripening; Double-Blind Method; Female; Humans; Isosorbide Dinitrate; Misoprostol; Nausea; Nitric Oxide Donors; Pregnancy; Pregnancy Trimester, First; Self Administration; Surveys and Questionnaires; Uterine Hemorrhage

A growing body of literature has shown that misoprostol alone could be effective for early medical abortion. We evaluated seven potential regimens in women up to 56 days of gestation in order to potentially identify an optimal regimen.. In phase I of the study, women requesting early abortion were randomized to one of three misoprostol regimens (4x400 microg po every 3 h, 2x800 microg po every 6 h, 1x600 pv microg); in phase II, women were randomized to one of two regimens (2x800 microg po every 3 h, 1x800 pv microg). In phase III, we consecutively tested two regimens (800 microg pv wetted with saline repeated after 24 h if intact gestational sac, 2x800 microg pv wetted with saline) to validate previously published results.. Although most women experienced some side effects, all regimens were tolerable and acceptable. Five of the seven regimens resulted in complete abortion rates of 60% or less. Only repeated doses of 800 microg pv misoprostol resulted in efficacy exceeding 60%.. Misoprostol-alone abortion regimens using oral misoprostol are too ineffective for clinical use or further investigation. Regimens with repeated dosing of misoprostol 800 microg pv warrant further study to find the optimal treatment protocol.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Drug Administration Schedule; Female; Humans; Logistic Models; Misoprostol; Pregnancy

Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of prostaglandins and concerns have been expressed that they might attenuate the effects of exogenous prostaglandins. This randomized study was conducted to evaluate whether NSAID given during medical abortion with mifepristone/misoprostol in the second trimester has a negative effect on the efficacy of the abortifacient by prolonging the induction-to-abortion interval.. Seventy-four women were treated with the anti-progesterone mifepristone, followed by repeated doses of misoprostol 36-48 h later. They were randomized to receive a prophylactic pain treatment of either paracetamol and codeine or diclofenac with the first dose of misoprostol.. Co-treatment of NSAID with misoprostol did not attenuate the efficacy of mifepristone and misoprostol. There was no significant difference between the NSAID and the non-NSAID group in the induction-to-abortion interval (5.4 versus 6.5 h) or the total doses of misoprostol needed (2 versus 3). The frequency of surgical intervention was similar (55.6 versus 52.6%). Women in the group treated with NSAID required significantly less opiates (P = 0.042).. Co-treatment with NSAID and misoprostol does not interfere with the action of mifepristone and/or misoprostol to induce uterine contractions and pregnancy expulsion in medical abortion. Prophylactic NSAID administration reduces the need for opiate injections.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Acetaminophen; Administration, Intravaginal; Adult; Anti-Inflammatory Agents, Non-Steroidal; Codeine; Diclofenac; Drug Therapy, Combination; Female; Gestational Age; Humans; Mifepristone; Misoprostol; Parity; Pregnancy; Pregnancy Trimester, Second

To compare the side effect profiles of regimens of oral and vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone and to investigate patients' perceptions of medical abortion.. Double-blind, randomised controlled trial.. Fifteen gynaecological clinics in 11 countries.. A total of 2219 healthy pregnant women requesting medical abortion with < or =63 days of amenorrhoea. Two thousand women were asked about their perceptions of the method.. Mifepristone 200 mg orally on day one, followed by 0.8 mg misoprostol either orally or vaginally on day three. The oral group (O/O group) and one of the vaginal groups (V/O group) continued with 0.4 mg of oral misoprostol, and the vaginal-only group (V-only group) with oral placebo, twice daily for seven days. Side effects were recorded daily by women and reported at each visit. After misoprostol administration at the clinic, side effects were recorded at 1-hour interval up to 3 hours. Patients' perceptions were asked at the second follow up visit, six weeks after treatment.. The outcome measures were the following: pregnancy-related symptoms (nausea, vomiting, breast tenderness, fatigue, dizziness, headache), drug-related side effects (diarrhoea, fever, rash and blood pressure change), side effects related to the abortion process (lower abdominal pain) and women's perceptions of the method.. The pregnancy-related symptoms decreased in all groups after misoprostol, and breast tenderness decreased already after mifepristone. Oral administration of misoprostol was associated with a higher frequency of nausea and vomiting than vaginal administration at 1 hour after administration. With oral misoprostol, diarrhoea was more frequent at 1, 2 and at 3 hours after administration than with vaginal administration. Misoprostol induced fever during at least 3 hours after administration in up to 6% of the women, this peak being slightly higher and taking place later with the vaginal route. Lower abdominal pain peaked at 1 and 2 hours after oral misoprostol, while it did so at 2 and 3 hours after vaginal misoprostol. In the two groups that continued misoprostol, 27% of women had diarrhoea between the misoprostol visit and the two-week follow up visit, compared with 9% in the placebo group. Among the women studied, 84% would choose medical abortion again, 9% would choose surgical abortion and 7% did not know. Twenty-three percent of the women would choose to have a possible future abortion at home, 70% at a health facility and 7% did not know.. The pregnancy-related symptoms decrease significantly with time during medical abortion. Nausea, vomiting and diarrhoea were more frequent after oral administration of misoprostol. Pain related to the abortion process occurs earlier after oral misoprostol. Should a need arise, a majority of women would choose medical abortion again and would prefer to have it at a health facility rather than at home.

Topics: Abdominal Pain; Abortifacient Agents, Steroidal; Abortion, Induced; Amenorrhea; Analgesics; Dizziness; Double-Blind Method; Fatigue; Female; Headache; Humans; Mifepristone; Misoprostol; Nausea; Parity; Patient Satisfaction; Perception; Treatment Outcome; Vomiting

The purpose of this study was to compare the efficacy and side effects of two different misoprostol regimens for second-trimester pregnancy termination.. We performed a randomized clinical trial in patients who were at 14 to 23 weeks of gestation and who were admitted for medical termination of pregnancy. All patients received 800 microg of vaginal misoprostol and were assigned randomly to 400 microg of oral misoprostol or 400 microg of vaginal misoprostol every 8 hours. Efficacy and side effects were compared. The mean induction time of the study group was compared with that of an historic control group that had received 400 microg vaginally every 12 hours.. Forty-three women were assigned randomly, 22 women to vaginal misoprostol and 21 women to oral misoprostol. Induction time and hospital stay were slightly shorter for the oral group; however, the differences were not significant. Side effects were similar for both groups.. After an initial 800 microg dose of vaginal misoprostol, a regimen of 400 microg of oral misoprostol every 8 hours is as effective as the same dose of vaginal misoprostol with no additional side effects, which provides a convenient alternative for midtrimester pregnancy termination.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Adult; Female; Gestational Age; Humans; Length of Stay; Misoprostol; Pregnancy; Time Factors; Treatment Failure

To compare the incidence of selected spontaneously reported adverse events (AEs) in patients with osteoarthritis (OA) treated with rofecoxib (VIOXX, 12.5 mg qd) or Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid).. Double-blind, parallel-group, 6-week study of patients aged > or = 40 years with a clinical diagnosis of OA treated with rofecoxib or Arthrotec. Primary endpoint: self-reported diarrhea; secondary endpoints: abdominal pain, discontinuations due to AEs, GI AEs and NSAID-type GI AEs (ie., acid reflux, dyspepsia, epigastric discomfort, heartburn, nausea, vomiting).. Among 483 patients (80.3% females, mean age 62.1), the rofecoxib group vs the Arthrotec group respectively reported diarrhea 6.2% vs 16.2% (p<0.001); drug-related diarrhea 3.7% vs 16.2% (p<0.001); one or more clinical AEs 52.9% vs 73.0% (p<0.001); GI AEs 28.9% vs 48.5% (p<0.001); NSAID-type GI AEs 18.6% vs 29.9% (p=0.004); discontinuations due to abdominal pain 0.4% vs 3.7% (p<0.05); and discontinuations due to any AE 4.1% vs 9.1% (p=0.029). No significant differences were observed in efficacy.. Rofecoxib 12.5 mg qd has improved GI tolerability and similar efficacy compared to Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid).

Topics: Abdominal Pain; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Cyclooxygenase Inhibitors; Diarrhea; Diclofenac; Double-Blind Method; Drug Combinations; Female; Humans; Lactones; Male; Middle Aged; Misoprostol; Osteoarthritis; Severity of Illness Index; Sulfones; Treatment Outcome

To determine the optimal dosage and dosing interval for the use of misoprostol administered vaginally for pre-operative cervical dilatation.. Prospective double-blind randomised study.. Fertility Control Centre, National University Hospital, Singapore.. Women were randomly allocated to either the 200 microg or the 400 microg misoprostol group. Vacuum aspiration was performed at either three or four hours after the insertion of misoprostol tablets. Using Hegar's dilatator, degree of cervical dilatation before operation was measured. Other parameters assessed included the amount of additional dilatation required (if it was < Hegar 8), pre-operative and intra-operative blood loss, and associated side effects.. For the 200 microg misoprostol group, only seven (23.3%) achieved a dilatation of > or = 8 mm compared with 29 women (96.7%) in the 400 microg misoprostol group. The odds ratio was 95.3 (95% CI 10.9-830.9) for 400 microg misoprostol for successful pre-operative cervical dilatation of > or = 8 mm. The mean cervical dilatation for 400 microg and 200 microg misoprostol was 8.2 mm and 6.4 mm, respectively (P < 0.001). The use of 400 microg misoprostol with an evacuation interval of three hours appears to be the optimal dosage and evacuation time interval. Increasing the time interval beyond three hours did not confer any additional advantage on the rate of successful cervical dilatation but was instead associated with an increase in side effects such as vaginal bleeding, lower abdominal pain and the appearance of products of conception at the cervical os. However, besides vaginal bleeding, no significant differences in the frequency of these side effects were demonstrated.. This first report on the comparison of differing dosages and time intervals to determine the optimal dosage treatment schedule shows that the vaginal application of 400 microg misoprostol for at least three hours is optimal for pre-operative cervical dilatation before vacuum aspiration in first trimester nulliparae.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Labor Stage, First; Misoprostol; Parity; Pregnancy; Pregnancy Trimester, First; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Hemorrhage; Vacuum Extraction, Obstetrical

A multicentre randomized open clinical trial was conducted to compare the efficacy and side effects of two regimens of mifepristone with misoprostol, and mifepristone with PG05 for termination of early pregnancy (amenorrhoea < = 49 days). Six-hundred women in early pregnancy, who requested medical abortion were randomly allocated into 3 groups. In group 1 (n = 301), an initial dose of mifepristone 50 mg was given, followed by 25 mg every 12 hours up to a total dose of 150 mg mifepristone, plus a single oral dose of misoprostol 600 micrograms in the morning of the third day. In group 2 (n = 150), the same regimen of mifepristone was given, but dl-15-methyl PGF2 alpha (PG05) 1 mg vaginal suppository was inserted on the third day. In group 3 (n = 149), a single dose of mifepristone 200 mg was given and misoprostol 600 micrograms was used as in group 1. The complete abortion rate were 94.4%, 97.3%, and 94.6% for group 1, 2 and 3, respectively. 3.0, 2.0 and 2.7% of women had incomplete abortion, and 1.7, 0.7 and 2.0% of women in the 3 groups were treatment failures; in the remaining 1% in group 1 and 0.7% in group 3, treatment outcome could not be determined. There were no significant differences among the 3 groups. Lower abdominal pain was the main complaint which was reported by 82% of the subjects after PGs administration. The incidence of diarrhoea in PG05 group (38.7%) was significantly higher than that in the other two groups (21.6 and 20.1%) (P < 0.001), and so was vomiting. It was concluded that misoprostol, as an orally effective prostaglandin, in combination with mifepristone for induced abortion of early pregnancy was as effective as PG05 vaginal suppository. Besides, it has advantages of convenience of use, less side effects, easy storage and transfer, and low cost.

Topics: Abdominal Pain; Abortion, Induced; Administration, Oral; Adolescent; Adult; China; Diarrhea; Dinoprost; Dose-Response Relationship, Drug; Female; Humans; Mifepristone; Misoprostol; Pessaries; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage

RU486 (mifepristone) followed by a prostaglandin (PG) analogue has been marketed in France since April 1990 as a medical alternative to surgery for early pregnancy termination. By law, the drug is used only in the centres approved for voluntary pregnancy termination, and its distribution is strictly controlled. Before being marketed, it was distributed to more than 20,000 women, as part of a training programme for the prescribers. Analysis confirmed an efficacy rate of 95.3%. Failures included incomplete ovular expulsion (2.8%), premature vacuum aspiration (0.7%) and ongoing pregnancy (1.2%). Pelvic pain and malaise were reported as side-effects in 1.6 and 1.2% of the cases respectively. Infectious complications were reported in 0.2% of the cases. Three severe adverse events (one of which was fatal) occurred, including myocardial infarction and ventricular arhythmia, in the hours following PG administration and justify a careful medical monitoring in the centre 3-4 h after administration of PG. For this reason, a trial was undertaken to evaluate the efficacy of an oral form of a PGE1 analogue (misoprostol). When RU486 was followed 36-48 h later by 400 micrograms of misoprostol, the efficacy rate was 96.9%, indicating an efficacy equivalent to that obtained with the other PG analogues. The distribution procedures were adequately followed by the prescribers and by the patients. In summary, RU486 constitutes a safe and efficient medical means of pregnancy termination, provided that the manufacturer's recommendations are properly followed.

Topics: Abdominal Pain; Abortion, Induced; Adult; Alprostadil; Contraindications; Dinoprostone; Female; France; Humans; Hypotension; Mifepristone; Misoprostol; Myocardial Infarction; Pilot Projects; Pregnancy; Uterine Hemorrhage

This three-way randomized crossover study in 18 healthy male volunteers compared the pharmacokinetics of 50 mg indomethacin b.d. during concomitant twice daily dosing with 400 micrograms misoprostol, 150 mg ranitidine or placebo. Plasma indomethacin concentrations were determined by HPLC assay of samples collected over 12 h after the first dose, and over 14 h after the last dose on Day 8 of each dosing period. A daily diary of bowel habits, and the occurrence and severity of abdominal symptoms, was kept by each subject throughout the study. Statistical comparisons were made by analysis of variance. In the presence of misoprostol there was a 13% decrease in the area under the plasma concentration-time curve of indomethacin over one dosing interval on Day 1 (P less than 0.01), and at steady state there was a 24% decrease in the maximum plasma concentration (P less than 0.02). The pharmacokinetics of indomethacin were not affected by co-administration of ranitidine. Accumulation of indomethacin after repeated oral dosing was not significantly altered by the co-administration of either misoprostol or ranitidine. The frequency and severity of abdominal symptoms was significantly increased (P less than 0.01) during misoprostol dosing, compared with either ranitidine or placebo plus indomethacin. When the dosing phase (Days 1-8) was compared with the washout phase (Days 9-15) in each period, misoprostol, but not ranitidine or placebo, plus indomethacin resulted in an increase (P less than 0.001) in abdominal symptom severity, frequency of bowel motions and a decrease in faecal consistency.

Topics: Abdominal Pain; Adolescent; Adult; Defecation; Digestive System; Drug Interactions; Feces; Humans; Indomethacin; Male; Misoprostol; Ranitidine

The differential diagnosis for ulcerating small bowel strictures is extensive and includes exposure to non-steroidal anti-inflammatory drugs (NSAIDs), Crohn's disease, infections, gastrointestinal lymphoma and vasculopathy. It also encompasses the exceptionally rare and poorly understood diagnosis of cryptogenic multifocal ulcerative stenosing enterocolitis (CMUSE), often a diagnosis of exclusion and considerable difficulty. We present a case of persistent proximal jejunal ulcerating stenoses in a 75-year-old Caucasian man, which continued despite cessation of NSAIDs. After extensive clinical, radiographic, laboratory and ultimately surgical pathological appraisal-as well as failure to improve with both misoprostol and budesonide-he was diagnosed with CMUSE and managed with limited small bowel resection. In the presentation of this case, we aim to underscore the diagnostic challenges that clinicians face in differentiating CMUSE from other more common diagnoses, particularly NSAIDs-induced enteropathy.

Topics: Abdominal Pain; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Constriction, Pathologic; Diagnosis, Differential; Enteritis; Humans; Intestinal Obstruction; Intestine, Small; Male; Misoprostol; Tomography, X-Ray Computed; Ulcer

To evaluate the approach to diagnosis and management of caesarean scar pregnancy (CSP) at a regional New Zealand hospital.. A retrospective case series of ten patients between June 2015 and May 2020. The data review included demographic information, ultrasound findings, human chorionic gonadotropin (HCG) levels, primary and subsequent treatment, outcomes and complications.. Nine women were diagnosed with CSP at a gestational age between four and ten weeks. One of these women was treated twice for two separate CSP within the study period. Treatment varied according to clinical presentation, HCG levels, gestational age, ultrasound findings and patient preference. Two thirds of women were successfully treated with primary management, with one third requiring multiple treatment modalities. We report one severe life-threatening haemorrhage and three cases resulting in hysterectomy. We also show a disproportionate number of Māori women presenting with CSP.. We present a series of ten cases of CSP and demonstrate similar challenges in regional New Zealand to those reported elsewhere. Management is heterogeneous with little guidance from the literature, and primary management was successful in seven out of ten cases. We report a disproportionately high number of cases in Māori women. Our results would support the development of a national register for caesarean scar pregnancy to improve diagnosis and management across New Zealand.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; Cicatrix; Dilatation and Curettage; Female; Humans; Hysterectomy; Methotrexate; Misoprostol; Native Hawaiian or Other Pacific Islander; New Zealand; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Prenatal; Uterine Hemorrhage

In Papua New Guinea induced abortion is restricted under the Criminal Code Law. Unsafe abortions are known to be widely practiced and sepsis due to unsafe abortion is a leading cause of maternal mortality.. We undertook a six month, prospective, mixed methods study at the Eastern Highlands Provincial Hospital. Semi structured and in depth interviews were undertaken with women presenting following induced abortion. This paper describes the reasons why women resorted to unsafe abortion, the techniques used, decision to seek post abortion care and women's reflections post abortion.. 28 women were admitted to hospital following an induced abortion. Reasons for inducing an abortion included: wanting to continue with studies, relationship problems and socio-cultural factors. Misoprostol was the most frequently used method to end the pregnancy. Physical and mechanical means, traditional herbs and spiritual beliefs were also reported. Women sought care post abortion due to excessive vaginal bleeding, and severe abdominal pain with some afraid they would die if they did not seek help.. In the absence of contraceptive information and services to avoid, postpone or space pregnancies, women in this setting are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk. Women need access to safe, effective means of abortion.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Abortion, Induced; Adolescent; Adult; Female; Gestational Age; Health Personnel; Health Services Accessibility; Hospitalization; Humans; Maternal Mortality; Medicine, Traditional; Misoprostol; Papua New Guinea; Plant Preparations; Pregnancy; Pregnancy, Unwanted; Prospective Studies; Socioeconomic Factors; Uterine Hemorrhage; Women's Health; Young Adult

The aim of the present study was to assess patient acceptability and satisfaction with medical treatment (vaginal misoprostol) of non-viable first trimester pregnancy.. A total of 64 women, treated with vaginal misoprostol for non-viable first trimester pregnancy between October 2012 and December 2012 at the First Department of Obstetrics and Gynecology Medical University of Warsaw, were included in this questionnaire-based study. Questions pertaining to advantages and disadvantages of misoprostol treatment as compared to potential surgical intervention were used. The respondents also determined whether they would choose medical treatment if they were to decide again. The Visual Analogue Scale (VAS) was used to assess pain and bleeding intensity.. Medical treatment was successful in 57 and surgical treatment was needed in 7 women. Average pain and bleeding intensity were 5.8 and 5.3, respectively. The most common side effects included diarrhea (27%), dizziness (22.2%), nausea (15.9%), and chills (15.6%). The most important advantages of misoprostol therapy were avoidance of the risk of uterine perforation (96.4%) and formation of intrauterine adhesions (74.6%), whereas the most significant disadvantages were prolonged bleeding (21.4%), pain (21.4%), and longer treatment duration (42.9%). Overall, 95.6% of the patients with successful treatment outcome declared they would choose this procedure if they were to decide again, as compared to 85.6% of women with treatment failure (p > 0.05).. Medical treatment with vaginal misoprostol is acceptable and well-tolerated by the vast majority of women with non-viable first trimester pregnancy. Satisfaction is expressed by both, respondents with successful as well as unsuccessful treatment outcome.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Dizziness; Female; Humans; Misoprostol; Nausea; Patient Acceptance of Health Care; Patient Satisfaction; Poland; Pregnancy; Pregnancy Trimester, First; Uterine Hemorrhage; Women's Health

To compare the level of pain reported by women by dose of mifepristone, 200 or 600mg, and describe the main factors related to the pain level in the 5 days after a medical abortion.. Observational study in 11 medical centers in France between October 2013 and September 2014. The protocols were 200 or 600mg orally mifepristone on day 1 of the medical abortion and 400, 600 or 800μg orally misoprostol on day 3. Women returned a questionnaire that they completed during 5 days following the abortion; pain was recorded on a visual analog scale (0-10) daily.. 453 women were included; the mean age was 29 years (range 18-49 years). Pain was greater with 200 than 600mg mifepristone: 33% of women reported a pain level of ≥8 on day 3 with 200mg as compared with 16% with 600mg. This difference remained after controlling for age, gestational age, gravidity, usual painful menstruation and misoprostol dose. Percentages of symptoms as vomiting or diarrhea were also lower with 600mg mifépristone than 200mg.. The mean pain severity experienced by women undergoing medical abortion is high; it is higher with a regimen of 200mg mifepristone. The findings emphasize the need to improve analgesic strategies and invite to opt for a protocol of 600mg instead of 200mg mifepristone.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adolescent; Adult; Age Factors; Analgesics; Female; France; Gravidity; Humans; Middle Aged; Mifepristone; Misoprostol; Pain Measurement; Pain, Postoperative; Pregnancy; Surveys and Questionnaires; Young Adult

Research on medical abortion has been conducted in Hong Kong since the 1990s. It was not until 2011 that the first-trimester medical abortion service was launched. Mifepristone was registered in Hong Kong in April 2014 and all institutions that are listed in the Gazette as a provider for legal abortion can purchase mifepristone from the local provider. This article aimed to share our 3-year experience of this service with the local medical community. Our current protocol is safe and effective, and advocates 200-mg mifepristone and 400-µg sublingual misoprostol 24 to 48 hours later, followed by a second dose of 400-µg sublingual misoprostol 4 hours later if the patient does not respond. The complete abortion rate is 97.0% and ongoing pregnancy rate is 0.4%. Some minor side-effects have been reported and include diarrhoea, fever, abdominal pain, and allergy. There have been no serious adverse events such as heavy bleeding requiring transfusion, anaphylactic reaction, septicaemia, or death.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adolescent; Adult; Clinical Protocols; Diarrhea; Drug Hypersensitivity; Female; Fever; Hong Kong; Humans; Middle Aged; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Failure; Young Adult

Female lower abdominal pain poses diagnostic difficulties for clinicians, especially when little more than the history and physical examination are available. A girl presented with constant lower abdominal pain after taking misoprostol for pregnancy termination. She was eventually referred to a rural District Hospital, where a laparotomy demonstrated acute appendicitis. After treating herself for a self-diagnosed pregnancy with illegally provided misoprostol, this patient presented with persistent lower abdominal pain. The differential diagnosis included ectopic pregnancy and all other causes of female abdominal pain. Yet diagnosing two diseases in the same anatomical area at the same time contradicts diagnostic parsimony. System problems in resource-poor areas can limit access to healthcare services and encourage dispensing potentially dangerous medications without clinicians' authorization. It is dangerous to rely on patients' self-diagnoses while neglecting other diagnoses. More than one diagnosis may be needed to explain temporally and anatomically related symptoms.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Appendicitis; Diagnostic Errors; Female; Humans; Misoprostol; Pregnancy; Young Adult

There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications.. Prospective observational study of consecutively enrolled patients.. A tertiary care university hospital in northern Portugal.. Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2-3 weeks later, and again after the following menses.. Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment.. Success rate was 86% (38/44) when absence of gestational sac on the 12 h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter < or = 15 mm was 51% (22/43), and with maximum sagittal plane area under 7.5 cm(2), 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37 degrees C. No apparent relationship between the size of ultrasound-estimated intra-uterine content and duration of symptoms was observed.. Absence of gestational sac on transvaginal ultrasound should be the criterion used to document success after medical management of first-trimester missed abortion, as it is associated with the highest short and long-term success rates, as well as mild and self-limited symptoms in the days following treatment.

Topics: Abdominal Pain; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Extraction, Obstetrical; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Uterine Hemorrhage

Endometritis and toxic shock syndrome associated with Clostridium sordellii have previously been reported after childbirth and, in one case, after medical abortion. We describe four deaths due to endometritis and toxic shock syndrome associated with C. sordellii that occurred within one week after medically induced abortions. Clinical findings included tachycardia, hypotension, edema, hemoconcentration, profound leukocytosis, and absence of fever. These cases indicate the need for physician awareness of this syndrome and for further study of its association with medical abortion.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Adolescent; Adult; Clostridium Infections; Clostridium sordellii; Diagnosis, Differential; Endometritis; Fatal Outcome; Female; Humans; Hypotension; Mifepristone; Misoprostol; Polymerase Chain Reaction; Pregnancy; Pregnancy Trimester, First; RNA, Ribosomal, 16S; Shock, Septic; Tachycardia; Uterus; Vomiting

To assess the effectiveness of intravaginal misoprostol for second trimester uterine evacuation, we studied 70 women with singleton pregnancies complicated by fetal malformation or dead fetuses. Participants received 200 microg misoprostol administered at 4-hour intervals. Gestations with dead fetuses had a shorter induction-abortion interval [14.2 hours, standard deviation (SD) 4.3] than those with live, malformed fetuses (20.2 hours, SD 7.3) (P< 0.001). The abortion rate was significantly higher for gestations with dead fetuses (92.1%) than those with live, malformed fetuses (68.8%) (P< 0.05). There were no major complications and no significant difference in the incidence of side-effects. All women aborted within 38 hours. Administration of misoprostol is an effective clinical method to terminate second trimester, complicated pregnancy.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Congenital Abnormalities; Diarrhea; Drug Administration Schedule; Female; Fetal Death; Fever; Gestational Age; Hospitals, Military; Humans; Jordan; Misoprostol; Nausea; Parity; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, Second; Time Factors; Treatment Outcome; Ultrasonography, Prenatal; Vomiting

The effect of misoprostol administered by different routes on pregnant uterine contractility was investigated.. Thirty-two women with a pregnancy between 8 and 11 weeks of gestation requesting termination of pregnancy were recruited. Misoprostol was administered either orally (0.4 mg), vaginally (0.4 mg) or sublingually (0.2 or 0.4 mg) according to consecutive allocation. Intrauterine pressure was recorded using a Grass polygraph connected to a pressure transducer 30 min before misoprostol was given and for 4 h thereafter. At the end of the recording, suction curettage was performed.. The first effect observed was an increase in uterine tonus, which occurred after a significantly shorter time following oral (7.8 min) and sublingual (10.7-11.5 min) than after vaginal (19.4 min) treatment. The time to maximum tonus elevation was also significantly shorter (39.5, 47.1-51.7 and 62.2 min for the three groups respectively). Regular uterine contractions developed in all subjects following sublingual and vaginal administration but not after oral administration. The increase in uterine activity measured in Montevideo Units was significantly higher after 2 h and thereafter for sublingual and vaginal treatment than for oral misoprostol.. Based on recording of uterine activity, sublingual misoprostol acts as rapidly as oral treatment, while development of contractions was similar to that seen following vaginal administration.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Induced; Administration, Intravaginal; Administration, Oral; Administration, Sublingual; Adult; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Time Factors; Uterine Contraction; Uterus; Vacuum Curettage

Misoprostol is a synthetic prostaglandin E1 used during the first trimester of pregnancy as an adjacent to RU486 for medical termination of pregnancy. We present a case of a healthy 23-year-old woman who was admitted due to misoprostol overdose, used to induce an illegal abortion. Manifestations of toxicity included abdominal pain, vomiting, diarrhea and confusion. Treatment was supportive and included gastric lavage and administration of activated charcoal. Recovery was completed within a few hours, and the patient was scheduled for a dilatation and curettage the following day.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Criminal; Adult; Diarrhea; Drug Overdose; Female; Gastric Lavage; Gestational Age; Humans; Misoprostol; Poisoning; Pregnancy; Vomiting

Rupture of unscarred uterus during the second trimester is rare. There have been only 32 cases reported in the literature since 1968. A case of ruptured uterus in a grand multiparous woman is presented. To our knowledge, this might be the first reported case in the English literature of uterine rupture during second trimester termination of pregnancy using a prostaglandin E1 analogue (Misoprostol) and oxytocin.

Topics: Abdominal Pain; Abortifacient Agents; Abortion, Induced; Administration, Intravaginal; Adult; Female; Fetal Death; Gestational Age; Humans; Hysterectomy; Misoprostol; Oxytocin; Parity; Pregnancy; Uterine Rupture

To evaluate the efficacy of a regimen of vaginal misoprostol in causing the complete expulsion of first-trimester missed abortions, or alternatively dilating the cervix for surgical evacuation.. Seventy-four women with a transvaginal ultrasound diagnosis of a first-trimester missed abortion and no more than slight vaginal bleeding were consecutively enrolled. Misoprostol (600 microg) was administered vaginally and repeated 4 h later if necessary. Surgical evacuation was performed when complete expulsion was not documented on the ultrasound 10-12 h after treatment.. Complete medical evacuation occurred in 42 women (56.8%), 11 (14.9%) of which required only one dose. Seventy women (94.6%) experienced abdominal pain, 73 (98.6%) vaginal bleeding, 10 (13.5%) nausea, 4 (5.4%) vomiting, 5 (6.8%) diarrhea, and 4 (5.4%) transient hyperthermia. There was one case of heavy vaginal bleeding requiring emergency surgical evacuation, and one re-admission for incomplete abortion at 30 days. All but 4 (5.4%) women had permeable cervices at the time of surgery.. The described regimen of vaginal misoprostol is safe and reasonably effective in inducing complete evacuation in missed abortions. When this does not occur, it almost always provides adequate cervical dilatation for surgery.

Topics: Abdominal Pain; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adolescent; Adult; Diarrhea; Drug Administration Schedule; Female; Fever; Humans; Misoprostol; Nausea; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Time Factors; Ultrasonography; Uterine Hemorrhage; Vomiting

To determine the effect of misoprostol, a synthetic prostaglandin E1 analogue, on the gastrointestinal tract (GIT) symptoms associated with non-steroidal anti-inflammatory drug (NSAID) administration and on the haemoglobin value, in children.. Retrospective chart review of children attending the paediatric rheumatology clinic at a tertiary referral hospital over a three year period, who were receiving NSAIDs and were prescribed misoprostol for treatment of GIT symptoms or anaemia.. Twenty five children (mean age 12.0 (SD 2.8) (range 7-17) years were prescribed misoprostol (mean dose 308.4 (76.5) micrograms/m2/day; 9.8 (2.5) micrograms/kg/day) while NSAID therapy was continued. Of the 22 (88%) patients with GIT complaints, 18 (82%) had complete resolution of symptoms and two (9%) had some improvement. Four patients (18%) had a recurrence of symptoms after initial resolution while still receiving misoprostol. Misoprostol therapy was associated with a statistically significant increase in haemoglobin concentration (mean value before misoprostol 115 (18) g/l; after misoprostol 126 (15) g/l (p = 0.02)). The only adverse effect reported was self limited diarrhoea in one child.. Misoprostol appeared to be effective in the treatment of GIT symptoms in children receiving NSAIDs and to result in significant increase in the haemoglobin concentration. Further prospective studies are needed to evaluate the role of misoprostol therapy for NSAID associated GIT complaints in the paediatric population.

Topics: Abdominal Pain; Adolescent; Anemia; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Child; Diarrhea; Female; Gastrointestinal Diseases; Hemoglobins; Humans; Male; Misoprostol; Retrospective Studies

In a cohort of children with juvenile rheumatoid arthritis treated with nonsteroidal antiinflammatory drugs and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers. Epigastric pain strongly correlated with documented gastroduodenal injury. Therapy with ranitidine or misoprostol led to clinical improvement. Nonsteroidal antiinflammatory drugs are associated with significant gastrointestinal abnormalities in children.

Topics: Abdominal Pain; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Child; Cohort Studies; Duodenitis; Gastritis; Humans; Misoprostol; Peptic Ulcer; Pilot Projects; Ranitidine