The contribution of alcohol, non-steroidal anti-inflammatory drugs (NSAIDs), and low dose aspirin (LDA) to upper gastrointestinal (GI) morbidity in a group of symptomatic patients who underwent upper GI endoscopy

Abstract

OBJECTIVE: To evaluate the contribution of alcohol, NSAIDs and LDA to GI morbidity in symptomatic patients undergoing upper GI endoscopy in a tertiary referral centre. Methods: Case notes of 1492 symptomatic patients who underwent oesophago-gastro-duodenoscopies from 1/3/2002 to 1/3/2004 were retrospectively analysed. RESULTS: Prior to endoscopy 220 had been on significant quantities of alcohol for at least 6 months, 95. had been on NSAIDS for at least 1 month, and 42 had been on LDA for at least 1 month. Alcoholics presented with haematernesis, malaena, and both in 43%, 33% and 20% respectively. 33% had proven alcoholic liver disease. Endoscopy showed oesophageal varices, portal hypertensive-gastropathy, antral gastritis and duodenitis, gastric erosions, oesophagitis, pangastritis, peptic ulcer disease (PUD) in 45%, 36%, 33%, 29%, 27%, 17% and 12% respectively. CLO test had been done in 64. It was positive in 18%. NSAIDs users also presented with dyspepsia, abdominal pain, upper GI bleeding, anaemia, and reflux symptoms in 25%, 18%, 17%, 15% and 9% respectively. Aspirin users had the -above in 40%, 17%, 36%, 11% and 9% respectively. Endoscopy revealed severe antral gastritis, duodenitis, gastric erosions, oesophagitis, PUD and pan-gastritis in 55%, 46%, 32%, 8%, respectively in NSAIDs users while same was observed in 68%, 36%, 36%, 30%, and 15% respectively in aspirin users. Overlapping pathologies were noted. CONCLUSIONS: Alcohol, NSAIDs, low dose aspirin cause significant upper GI morbidity. A third of alcoholic bleeders had proven alcoholic liver disease.