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. 1994 Aug;35(8):1030–1032. doi: 10.1136/gut.35.8.1030

Interobserver variation in assessment of gastroduodenal lesions associated with non-steroidal anti-inflammatory drugs.

N Hudson 1, S Everitt 1, C J Hawkey 1
PMCID: PMC1375049  PMID: 7926900

Abstract

Video endoscopic images were used to investigate whether gastroenterologists could agree on the definition of lesions within the stomach seen at endoscopy, with particular reference to those seen in patients taking non-steroidal anti-inflammatory drugs. Seven experienced endoscopists, unaware of the patients' clinical history or drug consumption, recorded their classification for 93 randomised video images of gastric lesions. There was complete agreement in the diagnosis of ulceration for nine images from patients who were not taking non-steroidal anti-inflammatory drugs; eight of nine were classified as deep ulcers, with 86% agreement for this subclassification. By contrast, the overall agreement for lesions in patients taking non-steroidal anti-inflammatory drugs was only 55%. Only nine of 44 ulcers were subclassified as deep, and there was considerable cross classification of non-haemorrhagic erosions and ulcers. In conclusion, ulcers that occur in patients taking non-steroidal anti-inflammatory drugs differ from those in patients who are not taking these drugs in that they are often more superficial and difficult to distinguish from erosions. The prognostic importance of these lesions is, therefore, uncertain.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aabakken L., Larsen S., Osnes M. Visual analogue scales for endoscopic evaluation of nonsteroidal anti-inflammatory drug-induced mucosal damage in the stomach and duodenum. Scand J Gastroenterol. 1990 May;25(5):443–448. doi: 10.3109/00365529009095513. [DOI] [PubMed] [Google Scholar]
  2. Calès P., Zabotto B., Meskens C., Caucanas J. P., Vinel J. P., Desmorat H., Fermanian J., Pascal J. P. Gastroesophageal endoscopic features in cirrhosis. Observer variability, interassociations, and relationship to hepatic dysfunction. Gastroenterology. 1990 Jan;98(1):156–162. [PubMed] [Google Scholar]
  3. Collins A. J., Du Toit J. A. Upper gastrointestinal findings and faecal occult blood in patients with rheumatic diseases taking nonsteroidal anti-inflammatory drugs. Br J Rheumatol. 1987 Aug;26(4):295–298. doi: 10.1093/rheumatology/26.4.295. [DOI] [PubMed] [Google Scholar]
  4. Geis G. S., Stead H., Wallemark C. B., Nicholson P. A. Prevalence of mucosal lesions in the stomach and duodenum due to chronic use of NSAID in patients with rheumatoid arthritis or osteoarthritis, and interim report on prevention by misoprostol of diclofenac associated lesions. J Rheumatol Suppl. 1991 Mar;28:11–14. [PubMed] [Google Scholar]
  5. Grant J. M. The fetal heart rate trace is normal, isn't it? Observer agreement of categorical assessments. Lancet. 1991 Jan 26;337(8735):215–218. doi: 10.1016/0140-6736(91)92169-3. [DOI] [PubMed] [Google Scholar]
  6. Hawkey C. J. Non-steroidal anti-inflammatory drugs and peptic ulcers. BMJ. 1990 Feb 3;300(6720):278–284. doi: 10.1136/bmj.300.6720.278. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hawthorne A. B., Filipowicz B. L., Edwards T. J., Hawkey C. J. High dose eicosapentaenoic acid ethyl ester: effects on lipids and neutrophil leukotriene production in normal volunteers. Br J Clin Pharmacol. 1990 Aug;30(2):187–194. doi: 10.1111/j.1365-2125.1990.tb03764.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Langman M. J., Brooks P., Hawkey C. J., Silverstein F., Yeomans N. Non-steroid anti-inflammatory drug associated ulcer: epidemiology, causation and treatment. J Gastroenterol Hepatol. 1991 Sep-Oct;6(5):442–449. doi: 10.1111/j.1440-1746.1991.tb00885.x. [DOI] [PubMed] [Google Scholar]
  9. Lanza F. L., Royer G. L., Jr, Nelson R. S., Chen T. T., Seckman C. E., Rack M. F. The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers: a gastroscopic and photographic study. Dig Dis Sci. 1979 Nov;24(11):823–828. doi: 10.1007/BF01324896. [DOI] [PubMed] [Google Scholar]
  10. Larkai E. N., Smith J. L., Lidsky M. D., Graham D. Y. Gastroduodenal mucosa and dyspeptic symptoms in arthritic patients during chronic nonsteroidal anti-inflammatory drug use. Am J Gastroenterol. 1987 Nov;82(11):1153–1158. [PubMed] [Google Scholar]
  11. Lockard O. O., Jr, Ivey K. J., Butt J. H., Silvoso G. R., Sisk C., Holt S. The prevalence of duodenal lesions in patients with rheumatic diseases on chronic aspirin therapy. Gastrointest Endosc. 1980 Feb;26(1):5–7. doi: 10.1016/s0016-5107(80)73248-0. [DOI] [PubMed] [Google Scholar]
  12. Morris A. D., Holt S. D., Silvoso G. R., Hewitt J., Tatum W., Grandione J., Butt J. H., Ivey K. J. Effect of anti-inflammatory drug administration in patients with rheumatoid arthritis. An endoscopic assessment. Scand J Gastroenterol Suppl. 1981;67:131–135. [PubMed] [Google Scholar]
  13. Silvoso G. R., Ivey K. J., Butt J. H., Lockard O. O., Holt S. D., Sisk C., Baskin W. N., Mackercher P. A., Hewett J. Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med. 1979 Oct;91(4):517–520. doi: 10.7326/0003-4819-91-4-517. [DOI] [PubMed] [Google Scholar]
  14. Sonnenberg A., Giger M., Kern L., Noll C., Study K., Weber K. B., Blum A. L. How reliable is determination of ulcer size by endoscopy? Br Med J. 1979 Nov 24;2(6201):1322–1324. doi: 10.1136/bmj.2.6201.1322. [DOI] [PMC free article] [PubMed] [Google Scholar]

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