Juvenile Polyposis Complicated with Protein Losing Gastropathy
NSAID Gastropathy Group B Lim, Imee – Lim, Mary. NSAIDS Weak organic acids that inhibit...
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NSAID GastropathyNSAID Gastropathy
Group B Lim, Imee – Lim, Mary
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NSAIDSNSAIDS
• Weak organic acids that inhibit biosynthesis of prostaglandins
• Anti-inflammatory, analgesic, antipyretic, antiplatelet effects
• Ex: Aspirin, Ibuprofen
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ProstaglandinProstaglandin
• Regulate the release of mucosal bicarbonate and mucus
• Inhibit parietal cell secretion• Important in maintaining mucosal blood flow• Epithelial cell restitution
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Symptoms:Symptoms:
• Epigastric pain (burning or gnawing)– Ill-defined, aching sensation, hunger pain– DU: 90min-3hrs after meals
Relieved by antacids or food• Pain that awakes the patient from sleep
– GU: pain precipitated by foodacid-induced activation of chemical receptors in the
duodenumenhanced duodenal sensitivity to bile acids and
pepsinor altered gastroduodenal motility
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• Complications– Variation in intensity or distribution of pain as well
as onset of associated symptoms– Penetrating Ulcer:
• Dyspepsia that is no longer relieved by food or antacids and radiates to the back
– Bleeding:• Tarry stool, coffee ground emesis
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– Perforation:• Severely tender, board-like abdomen• Sudden onset of severe generalized abdominal pain
– Gastric outlet obstruction• Pain worsening with meals, nausea and vomiting • Presence of succussion splash
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Risk FactorsRisk Factors
• Advanced age• History of ulcer• Concomitant use of glucocorticoids• High dose or multiple NSAIDS• Concomitant of use anticoagulants• Serious or multisystem disease
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Diagnosis
- Screening for Aspirin or NSAIDs in Blood and urine
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Treatment
• Goals of therapy - Treatment of active ulcer- Prevention of future injury
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Harrison's Principles of Internal Medicine 17th Ed
Recommendation for Treatment of NSAID related mucosal injury
Clinical Setting Recommendation
Active ulcer
NSAID discontinued
NSAID continued
H2 receptor antagonist or PPI
PPI
Prophylactic therapy Misoprostol
PPI
Selective COX-2 inhibitor
H. Pylori infection Eradication if active ulcer is present or there is a past history of peptic ulcer disease
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Harrison's Principles of Internal Medicine 17th Ed
Guide to NSAID TherapyNo/ Low NSAID GI Risk NSAID GI Risk
No CV risk
(no Aspirin)
Traditional NSAID Coxib or Traditional NSAID + PPI
Consider non-NSAID therapy
CV risk
(consider Aspirin)
Traditional NSAID + PPI if GI risk warrants gastroprotection
Consider non-NSAID therapy
A gastroprotective agent must be added if a traditional NSAID is prescribed
Consider non-NSAID therapy
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Prevention of NSAID induced Ulceration
• H2 receptor antagonist• Misoprostol • PPI
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NSAID gastropathy
• Patient’s history of taking diclofenac Na with concomitant use of clopidogrel
• Patient’s advanced age (65 years old)• Bleeding as complication of NSAID-induced
disease