Upper gastrointestinal problems in inhalational ketamine abusers

To study the association between upper gastrointestinal (GI) problems and inhalational ketamine abuse.

This is a retrospective study of 64 ketamine abusers treated from 2001 to 2008. Variables studied included clinical presentations, findings of upper GI endoscopy, abstinence from ketamine and relief of epigastric pain.

The following patients with (i) a previous history of upper GI problem; (ii) a history of non-steroidal anti-inflammatory drug (NSAID), aspirin or other substance abuse; and (iii) a known history of Helicobacter pylori (H. pylori) infection were excluded. The study group thus consisted of 37 ketamine abusers, of whom 28 had upper GI symptoms. Overall 14 of these patients had an upper endoscopy performed. The endoscopic diagnoses were: 12 (85.7%) with gastritis, one (7.1%) with gastroduodenitis, and one (7.1%) normal finding. Test for H. pylori, infection was negative. Abstinence from ketamine was found to be associated significantly with relief of symptoms (P= 0.027). Logistic regression showed the odds ratio of symptomatic relief for abstinence versus continued use of ketamine is 12.5 (95% CI[1.20, 130.6], P= 0.035). In patients whom an upper GI endoscopy was performed, H. pylori negative gastritis was the commonest histopathological finding (78.6%). Despite the use of medications, symptoms are commonly not relieved and that is associated with the continued abuse of ketamine.

Ketamine abusers frequently presented with upper GI symptoms, the commonest of which is epigastric pain (73% of abusers). Abstinence from ketamine abuse can lead to the relief of symptoms, which is an important message for ketamine abusers.