Interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs in cirrhotic patients with bleeding esophagogastric varices.

Abstract

BACKGROUND/AIMS:

Bleeding from esophagogastric varices is a life-threatening complication of chronic liver disease. As compared with esophageal varices (EV), the risk factors for bleeding from gastric varices remain unclear. This study examined interactions between anti-ulcer drugs and non-steroidal anti-inflammatory drugs (NSAIDs) as related to bleeding esophagogastric varices in cirrhotic patients.

METHODOLOGY:

Eighty-eight cirrhotic patients with an initial episode of bleeding esophagogastric varices who had not received prior treatment studied. The patients were divided 3 groups: 58 with bleeding from EV, 13 with bleeding from cardiac varices (CV), and 17 with bleeding from cardiofundic or fundic varices (FV). The use of "standard" NSAIDs on 4 or more of the last 7 days before the initial episode of bleeding was defined as "regular" use; all other use was considered "occasional".

RESULTS:

The number of anti-ulcer drug users was 16 (27.6%) in the EV group, 4 (30.8%) in the CV group, and 5 (29.4%) in the FV group. The number of NSAID users was 9 (15.5%) in the EV group, 4 (30.8%) in the CV group, and 11 (64.7%) in the FV group. The proportion of NSAID users was significantly higher in the FV group than in the EV group (p < 0.0001). All 16 users of anti-ulcer drugs who were nonusers of NSAIDs had varices with red color signs. All NSAID users had used NSAIDs orally within a day before the initial episode of bleeding. All "regular" NSAID users were nonusers of anti-ulcer drugs. All anti-ulcer drug users without red color signs were "occasional" NSAID users.

CONCLUSIONS:

"Occasional" oral NSAID use is an important step leading to variceal hemorrhage, especially in FV, even if the mucosa is protected by anti-ulcer drugs. The ability to use NSAIDs for several days without variceal bleeding in some patients with esophagogastric varices who are concurrently receiving anti-ulcer drugs suggests that such drugs might protect the esophagogastric mucosa.

• Authors: Hiroshi Yoshida, Yasuhiro Mamada, Nobuhiko Taniai, Sho Mineta, Youichi Kawano, Yoshiaki Mizuguchi, Daisuke Kakinuma, Tomohiro Kanda, Takashi Tajiri
• Journal: Hepato-gastroenterology (Hepatogastroenterology) 2009 Sep-Oct Vol. 56 Issue 94-95 Pg. 1366-70 ISSN: 0172-6390 [Print] Greece
• PMID: 19950793 (Publication Type: Journal Article)

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Anti-Ulcer Agents

Topics

• Aged
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects)
• Anti-Ulcer Agents (pharmacology)
• Drug Interactions
• Esophageal and Gastric Varices (complications)
• Female
• Gastric Mucosa (drug effects)
• Gastrointestinal Hemorrhage (etiology)
• Humans
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Risk Factors