[Upper gastrointestinal endoscopic findings and gastric mucosal blood flow in patients with rheumatoid arthritis]

In order to clarify the mechanism of peptic ulceration complicating rheumatoid arthritis (RA), the endoscopic examination of the stomach and duodenum, and the measurement of gastric mucosal blood flow (GMBF, ml/min/100 g) were performed in 49 patients with RA, in relation to the clinical variables (age, sex, disease duration, anatomical stage, functional class and disease activity) and drugs administered. Most of peptic ulcer (88%, 22/25) was found in the gastric mucosa in RA patients, of which antral ulcer occupied 82% (18/22). GMBF in the antrum was significantly lower in RA patients with antral ulcer than in those with normal gastric findings, while GMBF in the gastric body was rather higher in either patients with antral or other gastric ulcer, especially in patients with the angle or body ulcer. The prevalence of antral ulcer tended to be higher in females than in males, and GMBF in the antrum was significantly lower in the former than in the latter (42.7 +/- 11.0 vs 55.6 +/- 12.6). There was no relationship between the prevalence of antral ulcer or GMBF and the activity of RA. All the patients except 4 had received non-steroidal anti-inflammatory drugs (NSAIDs), and of these 45 patients, 24 had also steroids. The prevalence of antral ulcer was higher in patients taking NSAIDs and steroids more than 5mg prednisolone concomitantly than in those taking NSAIDs only, although there was no difference in GMBF in the antrum between them. The prevalence of antral ulcer in patients taking NSAIDs, according to the kind of NSAIDs taken, was the highest in phenylacetic acids group. The difference was significant between propionic acids group and phenylacetic acids group. GMBF in the antrum of phenylacetic acids group was the lowest among the three groups (34.7 +/- 7.1 in phenylacetic acids, 46.6 +/- 11.2 in oxicams and 47.7 +/- 12.6 in propionic acids). Those results indicate that long-term administration of NSAIDs may selectively inhibit GMBF in the antrum, leading to impairment of the protective mechanism in the gastric wall and subsequent occurrence of antral ulcer.