misoprostol and Arthritis--Juvenile

Thirteen juvenile chronic arthritis patients with abdominal symptoms related to non-steroidal anti-inflammatory drug therapy were endoscoped before and after a 6-week course of either misoprostol or ranitidine therapy. Major presenting symptoms were generalized abdominal pain and nausea. Symptoms did not correlate well with endoscopic findings which revealed no evidence of ulceration and minimal erosive damage. Five patients had mild erythema or gastritis. Bleeding lesions were confined to small numbers of petechiae. Following treatment with either misoprostol or ranitidine, patients improved symptomatically without a corresponding improvement on endoscopic and histological examination of stomach and duodenum. Both treatments were well tolerated.

Topics: Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Juvenile; Child; Child, Preschool; Duodenum; Dyspepsia; Endoscopy; Female; Gastrointestinal Diseases; Humans; Male; Misoprostol; Ranitidine; Stomach

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