Identification of nonsteroidal antiinflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis

doi:10.1016/S0022-3476(05)83556-5

The Journal of Pediatrics

Volume 122, Issue 4, April 1993, Pages 647-649

https://doi.org/10.1016/S0022-3476(05)83556-5 Get rights and content

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.

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Citation Excerpt :
Keenan et al. [4] reported a low incidence (0.7%) of gastropathy in children with juvenile rheumatoid arthritis (JRA) treated with NSAIDs, though other studies have reported a high prevalence of PUD in children taking aspirin and NSAIDs [5]. In fact, Mulberg et al. [6] reported in a cohort of children with RA treated with NSAIDs and referred for gastrointestinal complaints, more than 75% had gastritis, antral erosions, or ulcers. Even a single dose of NSAID could have toxic side effects, as Berezin et al. [7] described 4 children who were hospitalized for gastrointestinal bleeding after receiving only 1–2 doses of ibuprofen; all had a gastric ulcer visualized with EGD.
Non-steroidal anti-inflammatory drugs (NSAIDs) are a known cause of peptic ulcer disease, resulting in gastrointestinal bleeding or perforation. We present a case of a sixteen year old male athlete who presented with abdominal pain and was found to have a pyogenic liver abscess secondary to a gastrohepatic fistula due to a deeply penetrating ulcer from NSAID use. This patient was successfully managed with antibiotics, a proton pump inhibitor (PPI), percutaneous drainage, and bowel rest. Perforating peptic ulcer disease (PPU) is rare in children, and this is a novel report of a resulting gastrohepatic fistula and subcapsular hepatic abscess. In otherwise healthy adolescents with abdominal complaints, a careful history of NSAID use should be obtained.
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Supported in part by the New England Medical Center/National Institutes of Health Digestive Disease Core Center (Center for Gastroenterology Research for Absorptive and Secretory Processes, grant P30 DK 34928), by National Institutes of Health Pediatric Gastroenterology Research Training Grant (T 32 DK 07471), by the Affiliated Children's Arthritis Centers of New England, Bureau of Maternal and Child Health (grant MCJ 255064), and by a Physician Scientist Award (K11 DK 02077-01) from the National Institutes of Health (awarded to Dr. Mulberg).

Presented in part at the annual meeting of the American Gastroenterological Association, San Francisco, Calif., May 1992 (published in abstract form, Gastroenterology 1992;102:A22).

View full text

Identification of nonsteroidal antiinflammatory drug-induced gastroduodenal injury in children with juvenile rheumatoid arthritis†

Lancet

Gastroenterology

Managing NSAID-induced peptic ulcers

Drug Therapy

Treatment and prevention of non-steroidal antiinflammatory drug-induced gastrointestinal mucosal injury

Int J Clin Pharmacol Res

A double-blind placebo-controlled comparison of the efficacy and safety of 50,100 and 200 g of misoprostol QID in the prevention of ibuprofen-induced gastric and duodenal mucosal lesions and symptoms

Am J Gastroenterol

Misoprostol heals gastroduodenal injury in patients with rheumatoid arthritis receiving aspirin

Arch Intern Med

Nonsteroidal antiinflammatory drug-induced ulcers: management by traditional therapies

Gastroenterology