salicylates and Esophagitis

This study determines objectively the extent of nonsteroidal anti-inflammatory drug (NSAID) use in upper gastrointestinal (GI) mucosal acid-peptic diseases by supplementing the conventional interview with two tests of current aspirin (ASA) use--high-performance liquid chromatography (HPLC) for the presence of salicylates in serum and platelet cyclooxygenase activity, which detects ASA use within 5 days of testing. Of 186 consecutive patients undergoing upper endoscopy, 62% of 55 patients with esophagitis had evidence of current NSAID use, vs. 26% of 42 control patients with normal endoscopy (p less than 0.001), 12% of 17 patients with recently healed peptic ulcer (p less than 0.001), and 36% of 25 patients who had an active peptic ulcer (p less than 0.05), five of whom had concomitant esophagitis. Another 52 patients were ineligible for this analysis. Testing for platelet cyclooxygenase activity uncovered 26% more ASA users than history alone. In considering age, sex, smoking and drinking habits, arthritis, and ASA use by logistic regression, ASA use was the only factor contributing to esophagitis; ASA could not be further associated with severity, stricture or symptoms, however. In these patients, 95% of NSAID use was chronic, and 84% of that was ASA. These data show a previously unreported, strong association of ASA use with esophagitis, which suggests that ASA may be a significant factor in the resistance of esophagitis to current therapies as well as the frequently rapid relapse after therapy is withdrawn.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Blood Platelets; Chromatography, High Pressure Liquid; Drug Utilization; Endoscopy, Gastrointestinal; Esophagitis; Esophagoscopy; Humans; Medical History Taking; Peptic Ulcer; Prospective Studies; Prostaglandin-Endoperoxide Synthases; Salicylates

Bismuth subsalicylate was tested in an in vivo perfused rabbit model of oesophagitis for its ability to prevent the mucosal injury caused by pepsin. Treatment efficacy was assessed under both a treatment-before-injury protocol and a treatment-after-injury protocol. Oesophageal mucosal barrier function was evaluated by measuring flux rates of H+, K+, and glucose. The degree of oesophagitis was determined by gross and microscopic examination of the mucosa by several independent observers. Results showed that under both treatment protocols, bismuth subsalicylate significantly reduced the pepsin induced disruption of the mucosal barrier, as well as the morphologic changes. Bismuth subsalicylate when given after exposure to pepsin was also found to protect against the morphologic injury in a dose dependent manner. Experiments in vitro suggested that bismuth subsalicylate inhibits the proteolytic action of pepsin by interacting with pepsin, rather than with the pepsin substrate. We conclude that bismuth subsalicylate can protect the oesophageal mucosa against peptic injury, probably through inactivation of pepsin.

Topics: Animals; Bismuth; Disease Models, Animal; Dose-Response Relationship, Drug; Esophagitis; Esophagus; Mucous Membrane; Organometallic Compounds; Pepsin A; Rabbits; Salicylates

One hundred and eighty four patients aged over 65 years and hospitalised for gastrointestinal haemorrhage of high origin underwent emergency oesophago-gastro-duodenoscopy. It was thereby possible to make an aetiological diagnosis in 94.5% of cases. The study demonstrated certain special features: the preponderance of acute gastro-duodenal lesions, possibly explained by the high consumption of gastrotoxic drugs in the elderly subject; the relative frequency of oesophagitis (11%), one out of two cases being responsible for the bleeding; the discovery of a hiatal hernia in 59 patients (1/3 of cases), 25% of them bleeding from a lesion directly related to the latter. Bleeding was in large quantity in 57% of cases. Mortality, which was quite high (17%) appeared to be more related to the underlying general condition than to the haemorrhage itself. Endoscopy gave rise to complications in 8 patients, including 3 who died.

Topics: Aged; Anti-Inflammatory Agents; Duodenum; Endoscopy; Esophageal Diseases; Esophagitis; Esophagoscopy; Female; Gastrointestinal Hemorrhage; Gastroscopy; Hematemesis; Hernia, Hiatal; Humans; Male; Melena; Peptic Ulcer Hemorrhage; Salicylates

Four hundred consecutive patients, in a representative Southern California population, hospitalized for upper gastrointestinal hemorrhage, had endoscopic examinations performed within 24 hours of arrival in the emergency room. Seventy-four (18.5 percent) of these were found to have the typical lesions of acute hemorrhagic erosive gastritis. The clinical spectrum of this group is examined and a comparison made with a Veterans Hospital population reported previously.

Topics: Adult; Aged; Duodenal Ulcer; Esophageal and Gastric Varices; Esophagitis; Ethanol; Female; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Peptic Ulcer Hemorrhage; Salicylates; Sex Ratio; Stomach Ulcer

Topics: Acute Disease; Adult; Anticoagulants; Cortisone; Diagnostic Errors; Drug Synergism; Emergencies; Esophageal and Gastric Varices; Esophagitis; Ethanol; Gastritis; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Peptic Ulcer Hemorrhage; Retrospective Studies; Salicylates