Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 21, 2008; 14(43): 6704-6710
Published online Nov 21, 2008. doi: 10.3748/wjg.14.6704
Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent
Aliye Soylu, Can Dolapcioglu, Kemal Dolay, Aydin Ciltas, Nurgul Yasar, Mustafa Kalayci, Halil Alis, Nurten Sever
Aliye Soylu, Gastroenterology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul 34147, Turkey
Can Dolapcioglu, Gastroenterology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul 34865, Turkey
Kemal Dolay, Mustafa Kalayci, Halil Alis, General Surgery, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul 34147, Turkey
Aydin Ciltas, Nurgul Yasar, Internal Medicine, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul 34147, Turkey
Nurten Sever, Pathology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Istanbul 34147, Turkey
Author contributions: Soylu A led the research; Dolapcioglu C performed relevant literature; Dolay K, Kalayci M and Alis H performed the collection of study cases and evaluation of data; Ciltas A and Yasar N reviewed literature and Sever N performed the histopathological examinations.
Correspondence to: Dr. Aliye Soylu, Gastroenterology, Bakirkoy Dr Sadi Konuk Research and Training Hospital, Nezihi Ozmen Mahallesi 6.Gokler Sitesi A. 5 Blok, D:9 Merter, Istanbul 34147, Turkey. aliyesoylu@superonline.com
Telephone: + 90-532-6155606 Fax: + 90-212-5713278
Received: September 1, 2008
Revised: September 22, 2008
Accepted: September 29, 2008
Published online: November 21, 2008
Abstract

AIM: To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics.

METHODS: The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group I) with suicidal intent. Thirty patients with or without mild complaints of dyspepsia (group II) were selected as the control group. The study group was stratified according to the use of type and number of analgesics. Endoscopic findings were evaluated according to the Lanza score (LS), expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis.

RESULTS: Gastroduodenal damage was signifi-cantly more severe in group I compared to group II (P < 0.01). The LS was similar in both groups Ia and Ib. However LS was significantly higher in patients who had ingested multiple NSAIDs (group Ic) compared to other patients (P < 0.01). The LS was correlated to age (P < 0.01) and total amount of drug ingested (P < 0.05) in group I; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P > 0.05). The biopsy score (BS) was higher in group I than group II (P < 0.01), and higher in group Ib than group Ia (P < 0.05).

CONCLUSION: The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups. There is no significant difference in the LS between the groups. This lack of significance is remarkable in terms of the gastric effects of high-dose acetaminophen.

Keywords: Acute gastric injury; Nonsteroidal anti-inflammatory drug; Acetaminophen; Endoscopic lesion; Gastroscopy