Gastrointestinal disease, effect

Patients at increased risk of NSAID-induced gastrointestinal adverse effects (e.g., dyspepsia, peptic ulcer formation, and bleeding) include the elderly, those with peptic ulcer disease, coagulopathy, and patients receiving high doses of concurrent corticosteroids. Nephrotoxicity is more common in the elderly, patients with creatinine clearance values less than 50 mL/minute, and those with volume depletion or on diuretic therapy. NSAIDs should be used with caution in patients with reduced cardiac output due to sodium retention and in patients receiving antihypertensives, warfarin, and lithium. 

Ryan JC, Sleisenger MH Effects of systemic and extraintestinal diseases on the gut in Sleisenger MH, Fordtran JS (eds) Gastrointestinal Disease Pathophysiology/Diagnosis/ Management. Philadelphia, Saunders, 1993, pp 193-224. 

These drugs are used for gastrointestinal diseases (cohtis, enterocolitis, severe and chronic dysentery, sepsis, meningitis, pneumonia, infections of the urinary tract, and others caused by P. aeruginosa), when other antibiotics are ineffective. They are effectively nsed in the form of ointments for treating a few forms of eczema, boils, hidradenitis, and other skin diseases. 

COX-2 specific inhibition good choice for patients with inflammatory conditions who are at high risk of gastrointestinal adverse effects (e.g., older than 60 years history of peptic ulcer disease prolonged, high-dose NSAID therapy concurrent use of corticosteroids or anticoagulants)... 

Sulfasalazine is metabolized to sulfapyridine and 5-aminosalicylic acid, and it is thought that the sulfapyridine is probably the active moiety when treating rheumatoid arthritis (unlike inflammatory bowel disease see Chapter 63 Drugs Used in the Treatment of Gastrointestinal Diseases). Some authorities believe that the parent compound, sulfasalazine, also has an effect. In treated arthritis patients, IgA and IgM rheumatoid factor production are decreased. Suppression of T cell responses to concanavalin and inhibition of in vitro B cell proliferation have also been documented. It is not clear how these findings relate to the clinical efficacy of sulfasalazine in rheumatoid arthritis. 

Gastrointestinal Effects. Earlier studies of individuals with exposure to substances contaminated with 2,3,7,8-TCDD found significant elevations in self-reported ulcers (Bond et al. 1983 Suskind and Hertzberg 1984), but a study of Vietnam veterans (USAF 1991) failed to find such effects. A more recent study evaluated the gastrointestinal effects of exposure to substances contaminated with 2,3,7,8-TCDD in an occupational cohort (Calvert et al. 1992). More than 15 years earlier, the workers were employed in the manufacture of trichlorophenol and its derivatives at 2 chemical plants. A total of 281 workers participated in the medical study the control group consisted of 260 unexposed subjects who lived in the same communities as the workers. The participants underwent a comprehensive physical examination of the abdomen and rectum. The mean serum 2,3,7,8-TCDD level (on a lipid basis) for the workers was 220 ppt and was found to be highly correlated with years of exposure to 2,3,7,8-TCDD-contaminated substances controls had a mean serum 2,3,7,8-TCDD concentration of 7 ppt. At the time of examination, the workers were not found to be at increased risk for any gastrointestinal diseases. Moreover, neither... 

This group of compounds has both peripheral and central properties. It is known from ancient literature that atropine has psychotomimetic effects (extracts from Atropa belladona were used to induce hallucinations in wizards ). Central effects increase when the compounds are considered in the following rank atropine, scopolamine, benactyzine, Ditrane, and, finally, BZ and other esters of glycolic acid (Albanus, 1970). BZ was originally studied for the therapy of gastrointestinal diseases. But even in small doses it produces side effects, such as confusion and hallucinations. Therefore, BZ was withdrawn from commercial studies and turned over to the US Army as a possible candidate for incapacitating... 

Nonsteroidal anti-inflammatory drugs (NSAlDs) nonselectively inhibit the activities of both COX-1 and COX-2. Out of concern for the gastrointestinal side effects of NSAID, scientists have discovered and developed many specific COX-2 inhibitors that facilitate a safer choice for controlling inflammatory diseases (73). Eor example, NS-398, a selective COX-2 inhibitor, has been shown to reduce tension (mechanical stress)-induced PGE2 production from periodontal ligament cell cultures (74). 

In a randomized, double-blind, placebo-controlled trial in 328 patients with quiescent Crohn s disease, olsalazine 2 g/day given for 52 weeks was not superior to placebo in maintaining remission (13). Gastrointestinal adverse effects were significantly more frequent in the olsalazine group diarrhea was the most commonly reported adverse effect. 

Schiemann U, Kellner H. Gastrointestinale Nebenwirkungen der Therapie rheumatischer Erkrankungen. [Gastrointestinal side effects in the therapy of rheumatologic diseases.] Z Gastroenterol 2002 40(ll) 937-43. 

In a meta-analysis of 307 patients with rheumatoid arthritis from seven randomized clinical trials, of whom 147 took folate supplementation, hematological adverse effects were not significantly reduced in the folate group (8). However, there was a 79% reduction in mucosal and gastrointestinal adverse effects in patients taking folic acid and a non-significant trend toward a reduction (42%) in patients taking folinic acid. Disease activity was not modified by low doses of folate. Finally, the authors noted that folinic acid is more expensive. 

The commonest gastrointestinal adverse effects of aminophylline in adults are nausea and gastrointestinal irritation, which are primarily a function of serum theophylline concentrations, although some additional local irritation may be produced by oral administration. Nausea was reported in six of 20 asthmatic patients with serum theophylline concentrations of 20 pg/ml (SED-9, 4). In a survey of 2766 theophylline-treated patients with cardiac or pulmonary diseases, 11% had adverse effects, most of which were gastrointestinal disturbances (7.8%) (SED-9, 4). 

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