Internal Medicine

0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43

1068 NSAIDs

■Upper GI X-rays

➣less sensitive than endoscopy for detecting ulcers and should

NEVER be obtained in patients with GI bleeding

differential diagnosis

■Dyspepsia: gastroesophageal reflux disease, peptic ulcer disease,

gallstones, chronic pancreatitis, other drugs

■Upper GI bleeding: erosive esophagitis, esophageal varices, other

causes of ulcers, Mallory-Weiss tears, vascular lesions

■Chronic anemia: colorectal cancer or polyps, small intestinal ulcers

management

Dyspepsia:

■stop or change to another NSAID (e.g. a COX-2 inhibitor)

■trial of H2 receptor antagonist or proton pump inhibitor

■if symptoms persist despite above, upper GI endoscopy

GI bleeding

■hospitalize if hemodynamically significant or transfusion needed

■upper endoscopy to determine cause and treat

Severe abdominal pain

■plain and upright abdominal x-rays to diagnose GI perforation

■hospitalization and surgery usually required for GI perforation

specific therapy

■H2 receptor antagonists

➣for persistent dyspepsia despite changing NSAID

➣ranitidine or nizatidine

➣famotidine

➣cimetidine

➣side effects: (rare) bone marrow suppression, gynecomastia (with

cimetidine)

➣contraindications: gastric atrophy and achlorhydria

■Proton pump inhibitors

➣for persistent dyspepsia despite changing NSAID

➣for ulcer healing when NSAID must be continued

➣omeprazole, esoeprazole or rabeprazole

➣lansoprazole

➣pantoprazole

➣side effects: headache, diarrhea

➣contraindications: gastric atrophy and achlorhydria