Drug-induced upper gastrointestinal tract injury

Adverse effects of drugs, particularly of nonsteroidal anti-inflammatory drugs (NSAIDs), on upper gastrointestinal tract injury are significant.

Gastrointestinal symptoms, particularly nausea, anorexia, abdominal pain and dyspepsia, are found in as much as one-third of

patients as adverse reactions of medications. Antibiotics and nonsteroidal anti-inflammatory drugs are reported to be the most common

drugs to cause adverse events. Clinically, oesophageal changes present as retrosternal pain and odynophagia. Oesophageal lesions are

either temporary or permanent with strictures. Injury to the oesophageal mucosa may be induced by drugs with a local effect or by reducing

lower oesophageal sphincter tone and, thus, allowing gastro-oesophageal reflux. Injury to the gastric mucosa caused by NSAIDs

presupposes a reduction in mucosal prostaglandins that act as mucosal protection. Injury may occur with any route of administration of

NSAIDs, i. e. oral, rectal as well as parenteral. When detected on endoscopy, NSAID gastropathy presents as erythema, petechiae, aphthae,

erosions, haemorrhagic gastropathy and ulcers. The risk of manifestation of gastric and duodenal ulcer disease is increased by as much

as tenfold with the use of NSAIDs. The peak incidence occurs in the first three months of treatment; however, it may be manifested at

any time during the treatment with NSAIDs. Patients with risk factors should simultaneously receive proton pump inhibitors or can only

be given coxibs. Patients with previous gastrointestinal bleeding or those who take anticoagulants and require NSAIDs should receive

coxibs in combination with proton pump inhibitors and should be screened for the presence of infection with Helicobacter pylori.

Keywords: nonsteroidal anti-inflammatory drugs, NSAIDs, drug-induced oesophagitis, NSAID gastropathy