Upper gastrointestinal tract endoscopic injury in patients treated with different nonsteroidal anti-inlammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the main treatment for musculo-skeletal pain. However, they can cause different side effects, including NSAID-gastropathy, that can be detected by endoscopy.

Aim

To evaluate the effects of different NSAIDs on the upper gastrointestinal tract.

Material and methods

We retrospectively studied the results of upper gastrointestinal tract endoscopy in 6341 patients with rheumatic diseases (82.9% females, average age 50.8±15.7 years), who were admitted to our clinic in 2007-2016. All patients were treated with various NSAIDs for at least two weeks, including nimesulid (n=2315; 35.9%), diclofenac (n=1543; 24.0%), meloxicam (n=1177; 18.3%), ketoprofen (n=257; 4.0%), indomethacin (n=141; 2.2%), acelofenac (n=215; 3.4%), ibuprofen (n=118; 1.8%), etoricoxib (n=408; 6.3%), celecoxib (n=193; 3.0%), other NSAIDs (n=64; 1.0%). We evaluated the presence of the gastrointestinal erosions, multiple erosions ( 10) and ulcers and ≥10) и compared the occurence of the multiple erosions and ulcers in patients treated with etoricoxib and diclofenac depending on the presence of the risk factors for the NSAID-gastropathy (a history of gastrointestinal ulcer, age of 65 years, concomi≥10) и tant intake of low-dose aspirin).

Results

Treatment with etoricoxib (5.4%) and celecoxib (5.7%) was associated with a signicantly lower (p<0.05) occurence of the multiple erosions and ulcers compared with diclofenac (12.0%), ketoprofen (12.7%), indomethacin (13.2%) and ibuprofen (18.8%). In patients with the risk factors for NSAID-gastropathy, treatment with etoricoxib resulted in a significantly lower frequency of the multiple erosions and ulcers compared with diclofenac (a history of gastrointestinal ulcer: 9.7% and 24.4%, respectively, p<0.001, age of ≥10) и65 years: 8.9% and 16.0%, p<0.05, concomitant intake of low-dose aspirin: 11.3% and 30.1%, p<0.001).

Conclusion

Coxibs, including etoricoxib, induced NSAIDgastropathy significantly more rarely than nonselective NSAIDs, even in patients with the risk factors for NSAID-gastropathy.

Key words

NSAIDs, NSAID-gastropathy, risk factors, etoricoxib, diclofenac