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. 1971 Apr;47(546):227–232. doi: 10.1136/pgmj.47.546.227

Gastric ulcer and the anti-arthritic drugs

J H Emmanuel, R D Montgomery
PMCID: PMC2467092  PMID: 5576491

Abstract

Sixteen cases are described of gastric ulcer in patients receiving anti-arthritic drugs. Half of the ulcers were in the antrum or on the greater curve. Ten patients were under treatment with indomethacin and/or prednisone, seven of them receiving both drugs.

The ulcers healed readily when the drugs were withdrawn, and in the case of prednisone a continued daily dose of 10 mg or less did not prevent healing.

All the patients with haemorrhage were taking aspirin, with or without other drugs.

The literature is reviewed, and it is suggested that the increased incidence of peptic ulcer in patients receiving anti-arthritic drugs is confined to gastric ulcer. There is suggestive evidence of an increased susceptibility to antral ulcer in severe rheumatoid disease, which may largely account for the ‘steroid ulcer’.

Indomethacin is potentially ulcerogenic, and its combined use with steroids may be inadvisable. Apart from its tendency to produce haemorrhagic erosions, the role of aspirin in the aetiology of chronic ulcer remains doubtful. No serious ill-effects have been reported in the use of ibuprofen or Distalgesic in ulcer subjects.

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Selected References

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

  1. BARAGAR F. D., DUTHIE J. J. Importance of aspirin as a cause of anaemia and peptic ulcer in rheumatoid arthritis. Br Med J. 1960 Apr 9;1(5179):1106–1108. doi: 10.1136/bmj.1.5179.1106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BLACK R. L., YIELDING K. L., BUNIM J. J. Observations on new synthetic antirheumatic steroids and critical evaluation of prednisone therapy in rheumatoid arthritis. J Chronic Dis. 1957 Jun;5(6):751–769. doi: 10.1016/0021-9681(57)90082-6. [DOI] [PubMed] [Google Scholar]
  3. Chalmers T. M. Clinical experience with Ibuprofen in the treatment of rheumatoid arthritis. Ann Rheum Dis. 1969 Sep;28(5):513–517. doi: 10.1136/ard.28.5.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chapman B. L., Duggan J. M. Aspirin and uncomplicated peptic ulcer. Gut. 1969 Jun;10(6):443–450. doi: 10.1136/gut.10.6.443. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cooke A. R. Corticosteroids and peptic ulcer: is there a relationship? Am J Dig Dis. 1967 Mar;12(3):323–329. doi: 10.1007/BF02233653. [DOI] [PubMed] [Google Scholar]
  6. Croft D. N., Wood P. H. Gastric mucosa and susceptibility to occult gastrointestinal bleeding caused by aspirin. Br Med J. 1967 Jan 21;1(5533):137–141. doi: 10.1136/bmj.1.5533.137. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. DAVIES H. R., BARTER R. W., GEE A., HIRSON C. Observations on the use of butazolidin in arthritis. Br Med J. 1952 Dec 27;2(4799):1392–1394. [PMC free article] [PubMed] [Google Scholar]
  8. DOUGLAS R. A., JOHNSTON E. D. Aspirin and chronic gastric ulcer. Med J Aust. 1961 Dec 2;48(2):893–897. doi: 10.5694/j.1326-5377.1961.tb70101.x. [DOI] [PubMed] [Google Scholar]
  9. EVANS K. T. Peptic ulceration associated with prednisolone therapy. Br J Radiol. 1958 Jun;31(366):307–312. doi: 10.1259/0007-1285-31-366-307. [DOI] [PubMed] [Google Scholar]
  10. GRAY S. J., RAMSEY C., REIFENSTEIN R. W., BENSON J. A., Jr The significance of hormonal factors in the pathogenesis of peptic ulcer. Gastroenterology. 1953 Oct;25(2):156-72; discussion, 206-17. [PubMed] [Google Scholar]
  11. GRUBER C. M., Jr Codeine phosphate, propoxyphene hydrochloride, and placebo. J Am Med Assoc. 1957 Jun 29;164(9):966–969. doi: 10.1001/jama.1957.02980090020006. [DOI] [PubMed] [Google Scholar]
  12. Gibberd F. B. Dyspepsia in patients with rheumatoid arthritis. Acta Rheumatol Scand. 1966;12(2):112–121. doi: 10.3109/rhe1.1966.12.issue-1-4.13. [DOI] [PubMed] [Google Scholar]
  13. Gillies M. A., Skyring A. Gastric and duodenal ulcer. The association between aspirin ingestion, smoking and family history of ulcer. Med J Aust. 1969 Aug 9;2(6):280–285. doi: 10.5694/j.1326-5377.1969.tb105725.x. [DOI] [PubMed] [Google Scholar]
  14. HIRSCHOWITZ B. I., STREETEN D. H., POLLARD H. M., BOLDT H. A., Jr Role of gastric secretions in activation of peptic ulcers by corticotropin (ACTH). J Am Med Assoc. 1955 May 7;158(1):27–32. doi: 10.1001/jama.1955.02960010029007. [DOI] [PubMed] [Google Scholar]
  15. HOWELL D. S., RAGAN C. The course of rheumatoid arthritis during four years of induced hyperadrenalism (IHA). Medicine (Baltimore) 1956 May;35(2):83–119. doi: 10.1097/00005792-195605000-00001. [DOI] [PubMed] [Google Scholar]
  16. JANOWITZ H. D., WEINSTEIN V. A., SHAER R. G., CEREGHINI J. F., HOLLANDER F. The effect of cortisone and corticotropin on the healing of gastric ulcer: an experimental study. Gastroenterology. 1958 Jan;34(1):11–20. [PubMed] [Google Scholar]
  17. KAHN D. S., PHILLIPS M. J., SKORYNA S. S. The early penetration of experimental gastric ulcers in ra s receiving cortisone. Am J Pathol. 1961 Jan;38:73–87. [PMC free article] [PubMed] [Google Scholar]
  18. KAMMERER W. H., FREIBERGER R. H., RIVELIS A. L. Peptic ulcer in rheumatoid patients on corticosteroid therapy; a clinical, experimental and radiologic study. Arthritis Rheum. 1958 Apr;1(2):122–141. doi: 10.1002/art.1780010205. [DOI] [PubMed] [Google Scholar]
  19. KERN F., Jr, CLARK G. M., LUKENS J. G. Peptic ulceration occurring during therapy for rheumatoid arthritis. Gastroenterology. 1957 Jul;33(1):25–33. [PubMed] [Google Scholar]
  20. MASON R. M., HAYTER R. R. The present status of phenylbutazone therapy in rheumatic disease. Practitioner. 1958 Jul;181(1081):23–28. [PubMed] [Google Scholar]
  21. MELTZER L. E., BOCKMAN A. A., KANENSON W., COHEN A. The incidence of peptic ulcer among patients on long term prednisone therapy. Gastroenterology. 1958 Oct;35(4):351–356. [PubMed] [Google Scholar]
  22. MUIR A., COSSAR I. A. Aspirin and ulcer. Br Med J. 1955 Jul 2;2(4930):7–12. doi: 10.1136/bmj.2.4930.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Myles A. B., Bacon P. A., Williams K. A. Mefenamic acid in rheumatoid arthritis. Ann Rheum Dis. 1967 Nov;26(6):494–498. doi: 10.1136/ard.26.6.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. NASSIM J. R., PILKINGTON T. Toxic effects of phenylbutazone. Br Med J. 1953 Jun 13;1(4823):1310–1311. doi: 10.1136/bmj.1.4823.1310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. PALMER W. L., KIRSNER J. B. Therapeutic and side effects of the anti-inflammatory steroids on the gastrointestinal tract. Ann N Y Acad Sci. 1959 Oct 14;82:947–956. doi: 10.1111/j.1749-6632.1960.tb44975.x. [DOI] [PubMed] [Google Scholar]
  27. RAFFENSPERGER E. C. Multiple gastric ulcers occurring during phenylbutazone therapy. J Am Med Assoc. 1953 May 2;152(1):30–31. doi: 10.1001/jama.1953.63690010006007e. [DOI] [PubMed] [Google Scholar]
  28. REES H. A., WILLIAMS D. A. Long-term steroid therapy in chronic intractable asthma. A study of 317 adult asthmatics on continuous steroid therapy for an average period of 2 1/2 years. Br Med J. 1962 Jun 9;1(5292):1575–1579. doi: 10.1136/bmj.1.5292.1575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. ROTH J. L. ROLE OF DRUGS IN PRODUCTION OF GASTRODUODENAL ULCER. JAMA. 1964 Feb 8;187:419–422. doi: 10.1001/jama.1964.03060190034008. [DOI] [PubMed] [Google Scholar]
  30. SCOTT J. T., PORTER I. H., LEWIS S. M., DIXON A. S. Studies of gastrointestinal bleeding caused by corticosteroids, salicylates, and other analgesics. Q J Med. 1961 Apr;30:167–188. [PubMed] [Google Scholar]
  31. SPIRO H. M., MILLES S. S. Clinical and physiologic implications of the steroid-induced peptic ulcer. N Engl J Med. 1960 Aug 11;263:286–294. doi: 10.1056/NEJM196008112630606. [DOI] [PubMed] [Google Scholar]
  32. Sperling I. L. Adverse reactions with long-term use of phenylbutazone and oxyphenbutazone. Lancet. 1969 Sep 6;2(7619):535–537. doi: 10.1016/s0140-6736(69)90229-3. [DOI] [PubMed] [Google Scholar]
  33. TRUELOVE S. C., WITTS L. J. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955 Oct 29;2(4947):1041–1048. doi: 10.1136/bmj.2.4947.1041. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Taylor R. T., Huskisson E. C., Whitehouse G. H., Hart F. D., Trapnell D. H. Gastric ulceration occurring during indomethacin therapy. Br Med J. 1968 Dec 21;4(5633):734–737. doi: 10.1136/bmj.4.5633.732. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Valman H. B., Parry D. J., Coghill N. F. Lesions associated with gastroduodenal haemorrhage, in relation to aspirin intake. Br Med J. 1968 Dec 14;4(5632):661–663. doi: 10.1136/bmj.4.5632.661. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. WANKA J., JONES L. I., WOOD P. H., DIXON A. S. INDOMETHACIN IN RHEUMATIC DISEASES. A CONTROLLED CLINICAL TRIAL. Ann Rheum Dis. 1964 May;23:218–225. doi: 10.1136/ard.23.3.218. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. WATKINSON G. The incidence of chronic peptic ulcer found at necropsy: a study of 20,000 examinations performed in Leeds in 1930-49 and in England and Scotland in 1956. Gut. 1960 Mar;1:14–30. doi: 10.1136/gut.1.1.14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. WOOD P. H., HARVEY-SMITH E. A., DIXON A. S. Salicylates and gastrointestinal bleeding. Acetylsalicylic acid and aspirin derivatives. Br Med J. 1962 Mar 10;1(5279):669–675. doi: 10.1136/bmj.1.5279.669. [DOI] [PMC free article] [PubMed] [Google Scholar]

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