NSAIDs dyspepsia

The indications for these agents are in principle identical to those of the non-selective NSAIDs although the substances have not yet received approval for the whole spectrum of indications of the conventional NSAIDs. Because they lack COX-1-inhibiting properties, COX-2-selective inhibitors show fewer side effects than conventional NSAIDs. However, they are not free of side effects because COX-2 has physiological functions that are blocked by the COX-2 inhibitors. The most frequently observed side effects are infections of the upper respiratory tract, diarrhoea, dyspepsia, abdominal discomfort and headache. Peripheral oedema is as frequent as with conventional NSAIDs. The frequency of gastrointestinal complications is approximately half that observed with conventional NSAIDs. 

The most common adverse reactions seen with celecoxib include dyspepsia, abdominal pain, diarrhea, nausea, and headache Like other NSAIDs, celecoxib may compromise renal function. Elevation of aminotransferase levels also occurs. 

NSAIDs are one of the most widely used classes of medications in the United States, particularly in the elderly.4 More than 20,000 deaths occur in the United States per year as a direct result of adverse events related to NSAID use. Chronic NSAID ingestion leads to symptoms of nausea and dyspepsia in nearly half of patients. Peptic ulceration occurs in up to 30% of patients who use NSAIDs chronically, with gastrointestinal bleeding or perforation occurring in 1.5% of patients who develop an ulcer. NSAID-related peptic ulcers usually occur in the stomach duodenal ulcers are much less common. 

High-dose NSAID use NSAID-related dyspepsia... 

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. 

GI complaints are the most common adverse effects of NSAIDs. Minor complaints such as nausea, dyspepsia, anorexia, abdominal pain, flatulence, and diarrhea occur in 10% to 60% of patients. NSAIDs should be taken with food or milk, except for enteric-coated products (milk or antacids may destroy the enteric coating and cause increased GI symptoms in some patients). 

NSAIDs and Gl ulceration and bleeding, renal Blood in stool, black stool, dyspepsia. 

Many oncologists co-prescribe ranitidine and dexamethasone due to the gastric irritant effect of corticosteroids which can lead to dyspepsia, particularly if a patient is also concurrently receiving other gastrointestinal irritants such as non-steroidal anti-inflammatory drugs (NSAIDs). 

Clinical Knowledge Summaries (2008) Dyspepsia. Available at http //cks.library.nhs.uk/ dyspepsia unidentified cause/management/quick answers/Scenario dyspepsia no alarm features taking nsaids -328918 [Accessed 4 July 2008]. 

If the doctor decided that the cause of Mrs PJ s upset stomach may be NSAID-induced dyspepsia, it would be usual to stop NS AID treatment. However in the... 

The doctor may decide to stop the NSAID and see how Mrs PJ manages without the diclofenac or may consider adding in a proton pump inhibitor, in line with Clinical Knowledge Summaries (2008) guidance, to manage the incidence of NSAID-induced dyspepsia. If it is felt that the problem is related to the sulfasalazine and the nausea does not abate, the doctor may try an alternative treatment. As Mrs PJ is currently only on a low dose of sulfasalazine it would not really be possible to reduce the dose and still maintain efficacy. 

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. 

Nabumetone is a naproxen derivative, whose efficacy is related to its active metabolite, 6-methoxy-2-naphthyla-cetic acid. Not unexpectedly, a study in 2000 patients, mostly treated for more than 6 months, ehcited an adverse events pattern similar to the other derivatives of this class of NSAIDs (SEDA-13, 81). Adverse effects were reported in 18% of patients and 10% stopped taking the drug because of adverse reactions. Diarrhea was the most common problem (13%) followed by abdominal pain (9.9%), dyspepsia (9.3%), nausea (7.8%), and flatulence (4.7%). Ten ulcers were detected. Nervous system reactions, skin rashes, edema, unspecified eye disorders, and liver function test abnormahties aU occur (1). 

NSAID-related dyspepsia Duration of NSAID use Helicobacter pylori infection Rheumatoid arthritis (extent of disability)... 

Dyspepsia may or may not be associated with an ulcer, and in itself is of little clinical value when trying to identify subsets of patients who are most likely to have an ulcer. As many as 50% of patients who take NSAIDs report having dyspepsia. " Patients with dyspeptic symptoms may have either uninvestigated (no upper endoscopy) dyspepsia or investigated (underwent upper endoscopy) dyspepsia. If an ulcer is not confirmed in a patient with ulcer-like symptoms at the time of endoscopy, the disorder is referred to as nonulcer dyspepsia. ... 

Patients with PUD should eUminate or reduce psychological stress, cigarette smoking, and the use of nonselective NSAIDs (including aspirin). Although there is no antiulcer diet, the patient should avoid foods and beverages (e.g., spicy foods, caffeine, and alcohol) that cause dyspepsia or that exacerbate ulcer symptoms. If possible, alternative agents such as acetaminophen, nonacetylated... 

GI complications. The H2RAS may be used when necessary to relieve NSAID-related dyspepsia. 

Salicylates, NSAIDs Gastrointestinal bleeding, hepatic toxicity, renal toxicity, hypertension CBC, creatinine, urinalysis, AST, ALT Dark/black stool, dyspepsia, nausea/vomiting, abdominal pain, shortness of breath, edema CBC yearly, creatinine yearly... 

The most common adverse effects of NSAIDs involve the gastrointestinal tract. Minor complaints (nausea, dyspepsia, anorexia, and abdominal pain) are common (up to 60% of patients). Serious GI complications associated with NSAIDs including perforations, gastric outlet obstruction, and GI bleeding, occur in 1.5% to 4% of patients per year. 

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