Gastroscopic evaluation of anti-inflammatory agents

Area of Science:

• Gastroenterology
• Rheumatology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) and osteoarthritis (OA) patients often require anti-inflammatory agents.
• Assessing the gastrointestinal safety of these medications is crucial due to potential adverse effects.

Purpose of the Study:

• To evaluate the incidence and severity of gastric lesions in RA and OA patients using various anti-inflammatory drugs.
• To compare the gastric effects of single versus combined anti-inflammatory drug therapies.

Main Methods:

• 164 RA patients and 85 OA patients with no active gastric lesions underwent baseline gastroscopy.
• Patients received one of 12 anti-inflammatory drugs or combinations.
• Repeat gastroscopies were performed at 3-6 and 12 months to assess gastric damage.

Main Results:

• Gastric lesions were observed in 31% of patients (78/250), with similar rates in both RA and OA groups.
• Combined anti-inflammatory drug treatment led to a higher incidence of gastric lesions (51%) compared to single-drug therapy (23%).
• Aspirin showed the highest lesion rate (50%), while sulindac (11%) and diflunisal (10%) had the lowest; corticosteroids had a lower-than-expected incidence (14%).

Conclusions:

• All tested anti-inflammatory drugs can cause gastric damage, with combined therapies posing a significantly higher risk.
• Gastroscopy is essential for accurately assessing gastric tolerance, as patient-reported symptoms do not reliably correlate with endoscopic findings.
• Indiscriminate prescribing of anti-inflammatory drugs, particularly for osteoarthritis, should be reconsidered, emphasizing the need for careful monitoring.