Gastric erosion

The remaining commoner causes include oesophageal or acute gastric erosions, Mallory Weiss tears of the gastro-oesophageal junction and malignancy. 

Gastric lavage is contraindicated if corrosive or caustic substances have been taken, because oesophageal and gastric erosion and perforation may occur. 

Nonsteroidal anti-inflammatory drugs [P] Inhibition of platelet function, gastric erosions some agents increase hypoprothrombinemic response (unlikely with diclofenac, ibuprofen, or naproxen). 

Szabo S, Trier JS, Brown A et al. (1985) A quantitative method for assessing the extent of experimental gastric erosions and ulcers. J Pharmacol Meth 13 59-66... 

Some 500 million prescriptions for NSAIDs are written each year in the UK, and 10-15% of patients develop dyspepsia whilst taking these drugs. Gastric erosions develop in up to 80%, but these are usually self-limiting. Gastric or duodenal ulcers occur in 1-5%. The incidence increases sharply with age in those over 60, and the risk of ulcers and their complications is doubled in patients over 75 and those with cardiac failure or a history of peptic ulceration or bleeding. Ibuprofen may be less prone to cause these problems than other NSAIDs. 

Aminorex fumarate Aspirin Intimai and medical thickening of pulmonary arteries Endothelial damage, gastric erosion obliteration of small vessels, ischemic infarcts Pulmonary hypertension... 

The most common side effects of tolmetin are gastrointestinal side effects consisting of epigastric pain, dyspepsia, nausea, and vomiting. Tolmetin is able to cause gastric erosion and to prolong bleeding time. 

Ford, T. F., D. A. W. Grant, B. M. Austen, and J. Hermon-Taylor. 1985. Intramucosal activation of pepsinogens in the pathogenesis of acute gastric erosions and their prevention by the potent semisynthetic amphipathic inhibitor pepstatinyl-glycyl lysyl-lysine. Clinica ChimicaActa 145 37 7. 

Mucosal protectants - Sucralfate was the subject of a symposium, and its efficacy against experimental gastric erosions but Its lack of antlsecretory activity was confirmed. In a double blind trial,... 

Moore R. 1978. Bleeding gastric erosion after oral zinc sulfate. Br Med J i 754. 

Magnesium hydroxide increased the initial absorption of ibuprofen and flurbiprofen, but had no effect on ketoprofen. Unexpectedly, a pharmacodynamic study showed increased gastric erosions when ibuprofen was formulated with magnesium hydroxide. 

Bird MA, Amjadi D, Behrns KE (2002) Primary splenic lymphoma complicated by hematemesis and gastric erosion. South Med J 95 941-942... 

In this study, which was conducted in patients also participating in the OMNIUM study, patients whose initial endoscopy showed no peptic ulcer, 10 or fewer gastric erosions, 10 or fewer duodenal erosions and only mild dyspepsia were randomised to receive omeprazole 20 mg once daily in = 83) or placebo n = 86) and endoscoped routinely after 1, 3 and 6 months. In the study the estimated probability of remaining in remission for 6 months whilst receiving omeprazole was 0.78 compared with 0.53 placebo (Fig. 3), p = 0.004). Much of this difference was due to a reduction in the number of patients developing peptic ulcer from 16.5% with placebo to 3.6% in patients receiving omeprazole. 

Gastric erosions are aphthous ulcers that do not penetrate the muscularis mucosa. They are most often related to H. pylori infection (Levine and Rubesin 1995). Other causative agents include alcohol, salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs). They are also seen in critically ill patients due to multiple trauma, sepsis, shock, etc. At double-contrast barium studies, gastric erosions appear as shallow small, 1-2-mm-diameter collections of barium surrounded by a radiolucent rim of oedema an appearance mirrored at endoscopy with a haemorrhagic centre and oedematous rim (Fig. 5.2a,b) (Levine and Rubesin 1995 Sohn et al. 1995 Dheer et al. 2002). H. pylori infection is also related to the presence of lymphoid follicular hyperplasia, which is commonly present in patients with peptic ulcer disease (Fig. 5.3a,b) (Torigian et al. 2001). 

Hietanen, E. (1975) Mucosal and hepatic metabolism during the spontaneous disappearance of salicylate-induced gastric erosions. Amer. J. dig. Dis., 20,31. 

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