Drug‐induced gastric mucosal injury

Abstract

Although there is much of anecdotal information about drug injury to the gastric mucosa, only a few agents (e.g., salicylates, nonsteroidal‐nonsalicylate antiinflammatory compounds, and alcohol) have been studied in detail. The presence of acid in the gastric lumen is required for an injurious drug to cause clinically significant injury. Injury occurs as a result of the ability of certain drugs to increase the permeability of the mucosa to its own secreted acid lying within the lumen. As the tissue becomes overwhelmed by the diffusing acid, cell death occurs. Drugs that increase the diffusion of acid also interfere with cellular metabolism, an effect that is independent of the ability of the drug to increase diffusion of acid from the lumen into the tissue. However, when metabolic processes of the mucosa are depressed, the ability of the tissue to buffer diffusing acid is impaired. Thus, the quantity of acid diffusing into the tissue is not as important as the buffering capacity of the mucosa. Most instances of drug‐induced injury are not clinically apparent, yet significant hemorrhage occurs in some patients. Even though the initial episode of hemorrhage may be severe, aggressive nonoperative treatment usually is sufficient, provided the mucosa is no longer exposed to the injurious agent. Only a few patients require operation, the extent of which is still controversial.

Rifampicin-induced upper gastrointestinal bleeding

“…Eight days previously he was placed on isoniazid and rifampicin 10 mg/kg daily each for proved pulmonary tuberculosis. He had no gastrointestinal symptoms before the start of treatment, nor had he ingested any other drug including antipyretics and analgesics in the last 8 Antituberculous drugs were immediately stopped. He was given ranitidine, antacids and 2 units of blood transfusion and recovered over the ensuing 6 hours.…”

Symptoms in Patients with Peptic Ulcer and Hematemesis and/or Melena Related to the Use of Non-Steroid Anti-Inflammatory Drugs

“…Previous authors disagree on the role of nonsteroid anti-inflammatory drugs (NSAIDs) in the etiology of bleeding from peptic ulcers (1)(2)(3)(4)(5)(6)(7)(8) and the influence of these drugs on peptic ulcer symptoms (9)(10)(11)(12).…”

Protection of the Gastroduodenal Mucosa from the Effects of Diclofenac Sodium: Role of Highly Selective Vagotomy and Misoprostol

“…It has been stated that gastric acidity is necessary for the development of GDM lesions [32], but studies conducted to reduce gastric acidity with H 2 -receptor antagonist therapy [21][22][23][24] failed to protect the GDM from the effects of NSAIDs. The precise role of gastric acidity in the development of the mucosal lesions is still controversial, but we do know that reduction of gastric acidity is an important factor in healing of the lesions [43].…”