Lege Artis Medicinae

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

HERSZÉNYI László

MAY 16, 2007

Lege Artis Medicinae - 2007;17(04-05)

[Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used drugs worldwide. Gastroduodenal ulcers are found at endoscopy in 15 to 30% of patients who use NSAIDs regularly. The annual incidence of severe upper gastrointestinal complications such as bleeding or perforation is 1.0 to 1.5%. From a cost-benefit perspective, prevention strategies should consider both gastrointestinal, and recently, cardiovascular risk factors. No prophylaxis is necessary with low gastrointestinal risk. There are currently four possible strategies to reduce the risk of adverse gastrointestinal effects: 1. the use of selective COX-2 inhibitors or coxibs rather than traditional NSAIDs; 2. cotherapy, primarily with proton pump inhibitors, to ensure protection to gastric mucous membrane; 3. co-therapy with a coxib and a proton pump inhibitor in patients with very high risk (eg., history of bleeding); 4. eradication of Helicobacter pylori infection in patients with a history of ulcer. The use of coxibs decrease the risk of gastrointestinal damage by roughly 50%. In the presence of gastrointestinal risk factors or for patients on aspirin also treated with an NSAID or a coxib, protection with a proton pump inhibitor is recommended. Proton pump inhibitor therapy is also useful for the prevention and treatment of NSAID-induced dyspepsia. The beneficial effects of proton pump inhibitors cannot solely be explained by their profound antisecretory action. Therefore, several acid secretion- independent mechanisms of action have been proposed.]

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[INTRODUCTION - Erdheim-Chester disease is rare non-Langerhans cell histiocytosis with multisystem involvement. The histological hallmark of the disease is CD1a negative histiocyte proliferation. CASE REPORT - Histiocytosis presented in a 57- year-old Caucasian man with exophtalmus, which was after two years followed by progressive pericardial infiltration and effusion leading to cardiac compression and consequent functional disturbance. It was the histological analysis of a surgical sample removed during pericardial fenestration that revealed Erdheim- Chester disease. The patient died from multisystem involvement one year after the initial diagnosis. Postmortem examination showed long bone, orbital cavity and cranial cavity involvement as well as extensive retroperitoneal and mediastinal xanthogranulomatous infiltration. CONCLUSIONS - The clinical diagnosis of Erdheim-Chester disease is difficult because the symptoms are insidious and non-specific. The histological report is often only descriptive. The prognosis of the disease is poor due to the lack of targeted therapy and to the advanced stage at diagnosis.]

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