Gastric ulcer ibuprofen

C) Gastric ulceration heavy alcohol use increases the susceptibility of an individual to ibuprofen-induced GI toxicity... 

C. The likelihood of gastric ulceration and GI bleeding is increased by heavy alcohol use, poor health, advanced age, long-term NS AID use, and use of drugs such as corticosteroids and anticoagulants. Ibuprofen is not converted to a cardiotoxic metabolite. Dermal toxicities, such as epidermal necrolysis, are rare complications of ibuprofen therapy, but necrotizing fasciitis is not one of them. Confusion and ataxia are not side effects associated with ibuprofen, nor is eosinophilia. 

Ibuprofen is not recommended for use in animals. Dogs appear to be exquisitely sensitive to the propionic acid group of nonsteroidal anti-inflammatory drugs (NSAIDs) and easily develop gastric ulcers and renal failure. Seizures have been reported in both dogs and cats after ingestion of ibuprofen. 

NSAIDs, such as aspirin, IND, ketoprofen, ibuprofen, naproxen, sulindac and flurbiprofen, are widely used in treatment of chronic inflammatory diseases. Recent studies have also shown that they have activity in retardation of colonic tumor growth [89-91]. However, oral administration of NSAIDs usually generates gastrointestinal side effects (e.g. gastric ulcers and gastric perforation) [92]. Therefore, colon-specific and controlled release of NSAIDs are important to achieve sustained pharmacologic effects and reduce the side effects. 

Ibuprofen may cause gastric ulcers (63 ), and haematemesis has been reported (99 ). Gastric mucosal erythema and oedema with petechial haemorrhages and erosions have been reported (35 ). Tests for faecal occult blood may be positive (106 ). Ibuprofen suppositories may cause local irritation (110 ). 

The doctor hypothesized that the woman might have gastric or duodenal ulcers from NSAID therapy, and told her to collect three stool samples to be analyzed for the presence of blood. The doctor instructed the patient to discontinue using ibuprofen and aspirin until the actual reason for her pain could be diagnosed. She was to return for a follow-up visit in a few days. The doctor started treatment with an H2 receptor antagonist to prevent any further Gl irritation. 

More recently, it has been discovered that two different cyclooxygenase enzymes, called COX-1 and COX-2, are responsible for prostaglandin synthesis. COX-1 is involved with the usual production of prostaglandins, but COX-2 is responsible for the synthesis of additional prostaglandins in inflammatory diseases like arthritis. NSAIDs like aspirin and ibuprofen inactivate both the COX-1 and COX-2 enzymes. This activity also results in an increase in gastric secretions, making an individual more susceptible to ulcer formation. 

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. 

To study effects on clinically important GI complications with celecoxib, the CLASS study used celecoxib (400 mg twice daily, or twice the highest FDA-approved dose) compared to diclofenac and ibuprofen at standard dose. Celecoxib use was reported to be associated with a reduced incidence for the combined end point of symptomatic ulcers and ulcer complications (perforations, gastric outlet obstruction, or bleeding). Some subjects also used aspirin for car-dioprotection, but there is concern that GI safety of COX-2 inhibitors is blunted with use of concomitant aspirin (even 30 mg of aspirin can suppress gastric prostaglandin prodnction)." For patients taking aspirin and celecoxib, nicer complications were higher than with celecoxib only, but lower than with traditional NSAIDs. 

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