Background Continuous use of NSAIDs allows to control main symptoms and delay the progression of ankylosing spondylitis (AS). Although NSAIDs are known to cause serious gastrointestinal (GI) complications.
Objectives To evaluate visual upper GI tract changes in AS patients treated with NSAIDs
Methods Retrospective analysis of upper GI tract endoscopy findings in 447 AS pts (mean age 36.3±11.3, 25.8% females and 74.2% males), who underwent esophagogastroduodenoscopy (EGDS) during 2009-2013. At the time of EGDS procedure 402 pts (89.9%) were taking NSAIDs, predominantly diclofenac (34.5%), nimesulide (23.3%) and indomethacin (12.9%). Only 6% of pts were on selective NSAIDs (celecoxib and etoricoxib). Apart from NSAIDs pts were also taking sulfasalazine (15.9%), methotraxate (8.9%), glucocorticoids (GCs) (14.5%), biologic therapy (9.1%). 16.8% were administered proton pump inhibitors (PPI). 55 pts (12.3%) had the history of upper GIT ulcers, 9 (2.0%) pts were on low-dose aspirin (LDA). Dyspepsia were documented in 173 (38.7%) pts, heartburn and/or reflux was present in 84 (18.8%) pts.
Results Gastric and/or duodenal mucous erosions were found in 87 (19.8%), gastric and/or duodenal ulcers were found in 45 (10.1%). Ulcers were more common in males - OR 2.43 (95% CI 1.14 - 5.19), with previous history of ulcer - OR 8.41 (95% CI 4.24 - 16.6), use of LDA - OR 4.69 (95% CI 1.13 - 19.5). GCs intake and dyspepsia were not associated with increased risk of ulcer: OR 0.49 (95% CI 0.12 - 1.29) and OR 0.787 (95% CI 0.55 - 1.33). Use of selective COX-2 inhibitors and PPI decreased the risk of upper GI tract ulcers: OR 0.37 (95% CI 0.48 - 2.78) and OR 0.45 (95% CI 0.25 - 0.81).
Conclusions Upper GI tract ulcers and erosions are quite common comorbidities in AS pts, associated with long-term use of NSAIDs. In the majority of cases these conditions remain asymptomatic. Major risk factors for upper GI tract ulcer/erosions development are: male sex, history of ulcer and current use of LDA. Administration of PPI and selective COX-2 inhibitors would reduce the risk of GI complications.
Disclosure of Interest None declared
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