RESUMO
Peroral endoscopy was performed in 56 patients with rheumatic disease who had been taking 8 or more aspirin tablets daily for more than 3 months yet who had no major gastrointestinal symptoms or history of peptic ulcer disease. Duodenal mucosal lesions were observed in 16 patients; 15 (27%) had erythema, 7 (13%) had erosions, and 2 (4%) had ulcers. The prevalence of duodenal lesions was the same in patients taking regular, buffered, or enteric-coated aspirin preparations. Patients with duodenal lesions were more likely to have associated gastric lesions.
Assuntos
Aspirina/efeitos adversos , Duodenopatias/induzido quimicamente , Doenças Reumáticas/tratamento farmacológico , Adulto , Idoso , Artrite Reumatoide/tratamento farmacológico , Aspirina/uso terapêutico , Soluções Tampão , Duodenopatias/diagnóstico , Duodenopatias/epidemiologia , Úlcera Duodenal/induzido quimicamente , Endoscopia , Eritema/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/epidemiologia , Comprimidos com Revestimento EntéricoRESUMO
Endoscopy was done in 82 patients with rheumatic disease who were receiving chronic aspirin therapy. Fifty-eight patients were taking at least eight aspirin tablets daily for 3 or more months; 24 patients were taking, in addition to the aspirin, a maximum of one other antiinflammatory, nonsteroidal medication. Endoscopy in 45 normal subjects not taking aspirin showed no ulcers or erosions and a 4% incidence of gastric erythema. In the 82 patients with rheumatic disease, 14 (17%) had gastric ulcers, 33 (40%) had gastric erosions, and 62 (76%) had gastric erythema. Regular aspirin and buffered aspirin users had an ulcer incidence of 23% and 31% respectively, compared with a 6% incidence in enteric-coated aspirin users (P less than 0.05). One third of all patients with gastric ulcer had no gastrointestinal symptoms. Patients taking chronic aspirin therapy for rheumatic diseases have a higher than suspected incidence of gastric ulcer and erosions. Gastric ulcer may exist without symptoms in such patients.
Assuntos
Aspirina/efeitos adversos , Doenças Reumáticas/tratamento farmacológico , Gastropatias/induzido quimicamente , Adulto , Idoso , Aspirina/administração & dosagem , Aspirina/sangue , Soluções Tampão , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/sangue , Gastropatias/diagnóstico , Úlcera Gástrica/induzido quimicamente , Comprimidos com Revestimento EntéricoRESUMO
A 25-year-old white man with gout and nephropathy and with a previous reaction to allopurinol was given a trial dose of oxypurinol. He developed malaise, a generalized erythematous reaction with edema, pruritus, and emesis; this was clinically identical to the reaction he experienced with allopurinol. When the patient's lymphocytes were exposed in vitro to oxypurinol and allopurinol, increased DNA synthesis was observed, suggesting an immunologic basis for the reaction. This patient indicates that clinical cross reactivity to allopurinol and oxypurinol does occur and may be of an immunologic basis. There is a need for additional xanthine oxidase inhibitors for such patients.
