Endoscopic study

In some cases, these extra-esophageal symptoms may be the only ones present, making it more difficult to recognize GERD as the cause, especially when endoscopic studies are normal. 

Bini, E.J., Lascarides, C.E., Micale, P.L., Weinshel, E.H. Mucosal abnormalities of the colon in patients with portal hypertension an endoscopic study. Gastrointest. Endosc. 2000 52 511-516... 

Gastrointestinal adverse effects are particularly frequent, and affect some 14-25% of patients the incidence of the most serious, peptic ulcer and bleeding were 0.16-0.34% and 0.16-0.17%, respectively (1). A prospective 12-week endoscopic study documented better gastrointestinal tolerability with diclofenac than naproxen (SEDA-20, 92). Upper gastrointestinal hemorrhage has been associated with transdermal application of diclofenac, with massive bleeding in two of four patients (SEDA-21, 104). 

Lanza FL, Arnold JD. Etodolac, a new nonsteroidal antiinflammatory drug gastrointestinal microbleeding and endoscopic studies. Clin Rherrmatol 1989 8(Suppl 1) 5-15. 

Flosulide caused less damage to the mucosa and was better tolerated than naproxen in a 2-week endoscopic study, but the clinical relevance of endoscopic studies of this sort is debatable (SEDA-14, 79). 

There are very few data on the gastrointestinal toxicity of over-the-counter doses of ketoprofen. In an endoscopic short-term study in healthy subjects ketoprofen was associated with significant gastrointestinal toxicity (9). Another endoscopic study showed that the i -enantiomer of ketoprofen has less gastrointestinal toxicity than the racemic mixture or the 5-enantiomer while retaining good analgesic activity (SEDA-22,116). 

Gastrointestinal symptoms (pyrosis, pain, nausea) can occur (1), but in a short-term endoscopic study nimesulide caused less gastric damage than indometacin (SEDA-15, 104). 

The ability of the gastroduodenal mucosa to adapt to repeated exposure to NSAIDs and aspirin is well documented, and some reports have shown the possible involvement of H. pylori in this process (76,81). In one endoscopic study in volunteers, mucosal adaptation to naproxen after 4 weeks of treatment occurred in 53% of H. py/on-positive subjects and in 81% in H. py/on-negative subjects (82). 

Parecoxib sodium is an injectable COX-2 inhibitor developed for the treatment of acnte pain. It is a prodrug of a sulfonamide-based COX-2 inhibitor, valdecoxib, a potent anti-inflammatory and analgesic dmg. The published information on this componnd is inadequate to draw any conclusion about its tolerability. Single-dose and mnlti-ple-dose studies have not shown any safety problems compared with placebo (1 ). In small short-term endoscopic studies parecoxib was much better tolerated than the non-selective NSAID ketorolac (5,6). However, it shonld be noted that valdecoxib was withdrawn in 2005 (7). 

In an endoscopic study of the acute gastroduodenal toxicity of intravenous cisplatin 10 mg/m and etoposide 107 mg/m (mean dose) given for three doses, a significant number of patients developed gastroduodenal lesions, several of which progressed (188). 

Sartori S, Nielsen 1, Maestri A, Beltrami D, Trevisani L, Pazzi P. Acute gastroduodenal mucosal injury after cisplatin plus etoposide chemotherapy. Clinical and endoscopic study. Oncology 1991 48(5) 356-61. 

Pace F, Lazzaroni M, Bianchi-Porro G. Failure of sucralfate in the treatment of refractory esophagitis vs. high dose famotidine An endoscopic study. Scand J Gastroenterol 1991 26 491-494. 

Fiorucci, S., Santucci, L., Gresele, P., Faccino, R.M., Del Soldato, P., and Morelh, A., Gastrointestinal safety ofNO-aspirin (NCX-4016) in healthy human volunteers a proof of concept endoscopic study. Gastroenterology, 124,600-607,2003. 

Recently, interest in the CT study of the middle ear has been renewed by detailed endoscopic studies of this region performed during interventions with dedicated devices this technique has been called transtympanic endoscopy, since it requires the perforation of the tympanic membrane. 

Endoscopic studies also supported these data [25-27]. In one study, 15 healty subjects received either omeprazole 60 mg om or placebo for 4 days. One hour after the last intake of the drug, 1 g of aspirin was taken and endoscopy was carried out 2h later. Fourteen out of 15 subjects showed more than one erosion if aspirin was taken with placebo, whilst none on omeprazole did (p<0.0001). 

In a third endoscopic study, 36 healthy volunteers were dosed with the lower doses of aspirin associated with cardiovascular protection (300 mg daily) for 14 days. In subjects receiving placebo the median injury score rose from 1 (baseline) to 10 at the end of 14 days. Subjects receiving 20 mg of omeprazole daily had a reduction in their median score to 1, that is comparable to baseline. 

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