drug-induced gastropathy
Introduction
Introduction to drug-induced stomach diseases Gastropathy of Drugs is a drug-induced adverse drug reaction in the stomach, accounting for about one-third of the drug side effects. Many oral medications can cause stomach upset, but sometimes oral administration can cause stomach upsets such as nausea, vomiting, and loss of appetite. The clinical manifestations of drug-induced gastric diseases vary depending on the type of drug, the dose, and whether it is combined with stimulating stomach drugs. However, the stomach is stimulated, the gastric mucosal barrier suffers from different degrees of stomach damage, and severe gastric ulcers occur. With bleeding. basic knowledge The proportion of illness: 0.0851% Susceptible people: no specific population Mode of infection: non-infectious Complications: gastric ulcer gastritis gastrointestinal bleeding
Cause
Cause of drug-induced stomach disease
Drug interference
Gastric mucosal epithelial cells synthesize mucin, affecting the quality and quantity of gastric mucus; inhibit mucosal prostaglandin synthesis, inhibit normal proliferation of mucosal epithelial cells, renew and granulation tissue formation, damage the gastric mucosal barrier, renew and granulation tissue formation, and make the stomach The mucosal barrier is destroyed, the obstacle is repaired, and the gastric mucosa is eroded to form an ulcer.
Stomach acid
Gastric mucosa glands normally stimulate gastric acid, pepsin secretion, some drugs reduce thrombocytopenia, inhibit platelet aggregation, reduce prothrombin and cause upper gastrointestinal bleeding.
Mucosal stimulation
Some drugs have stimulating and corrosive effects on the gastric mucosa, such as potassium chloride and iron salts. Some drugs affect the gastrointestinal motility and blood and lymph circulation of the gastric mucosa, and damage the normal function of the gastrointestinal tract.
Prevention
Drug-induced stomach disease prevention
1. Before the medication, understand whether the patient has a history of ulcer disease and other stomach diseases, and whether there is liver disease.
2. The medication should be clearly indicated, and drugs that are irritating to the stomach should be cautious.
3. Apply adrenocortical hormone, antipyretic analgesics, antibiotics, and close observation of stomach symptoms during medication.
4. Some medicines choose a safe dosage form, such as taking potassium as a water-based agent, taking aspirin for a long time, and using enteric solvents.
5. Try not to take multiple drugs at the same time, especially those that are irritating to the stomach.
Complication
Drug-induced gastric disease complications Complications, gastric ulcer, gastritis, gastrointestinal bleeding
Prone to gastric ulcer or gastritis, gastrointestinal bleeding.
1, gastric ulcer
Chronic gastritis is prone to ulcer disease. Ulcers usually occur in gastritis. The onset of gastric ulcer is related to diet, occupation, smoking, genetics, etc., and pyloric sphincter dysfunction or bile reflux can cause gastric acid secretion. Increasing and destroying the gastric mucosal barrier will further form ulcers on the basis of gastritis.
2, upper gastrointestinal bleeding
Upper gastrointestinal bleeding is the most common complication of peptic ulcer. Peptic ulcer is also the most common cause of upper gastrointestinal bleeding. If ulcer treatment is not timely, or overeating, alcoholism, overwork and irrational use, And rupture bleeding.
3. Acute perforation
Acute perforation means that the ulcer penetrates deep into the muscular layer and the serosal layer and suddenly penetrates the stomach wall, causing the stomach or the duodenal fluid to flow into the abdominal cavity, causing diffuse peritonitis.
4, pyloric obstruction
Duodenal or pyloric canal ulcers due to inflammation, edema, pyloric spasm, gastric sag or scar contraction caused by pyloric stenosis, food obstruction, known as pyloric obstruction.
5, bile reflux gastritis after gastrectomy, bile reflux gastritis after gastrectomy, refers to gastritis after gastrectomy, due to pyloric insufficiency and bile reflux.
6, cancer.
Symptom
Symptoms of drug-induced stomach disease Common symptoms Cancer gastrointestinal symptoms Late stomach yin deficiency nausea Stomach erosion Abdominal pain Appetite decline Upper gastrointestinal bleeding Peptic ulcer
The main condition for diagnosis is that during the course of medication, gastric symptoms appear and can be ruled out by other causes. Fiber gastroscopy shows extensive gastric congestion, multiple erosions, bleeding points, superficial ulcers, and sometimes activity in the stomach. The phenomenon of oozing, the lesions are mostly located in the corpus, a few involving the lower esophagus and duodenum, tissue biopsy of the lesion, often inflammatory cell infiltration, superficial mucosal necrosis, hemorrhage.
The clinical manifestations of drug-induced gastric diseases vary depending on the type of drug, the dose, and whether it is combined with stimulating stomach drugs. However, the stomach is stimulated, the gastric mucosal barrier suffers from different degrees of stomach damage, and severe gastric ulcers occur. With bleeding.
1. Antipyretic analgesics
Such as aspirin, indomethacin, inflammatory pain Xi Kang, Bao Taisong, ibuprofen, etc., easy to cause upper abdominal pain and discomfort, severe upper gastrointestinal bleeding, gastroscopy often have gastric mucosal inflammation, erosion and ulcer, bleeding, upper digestion Road bleeding is more common in adults, occasionally in infants and young children.
2. Antibiotics
Many oral antibacterials such as tetracyclines, erythromycin, metronidazole, furans, etc., oral susceptibility, vomiting, abdominal pain, loss of appetite, aggravation of peptic ulcer and even bleeding; Bralow et al reported that after oral penicillin, in addition to the general stomach In addition to intestinal symptoms, acute abdominal pain and gastrointestinal bleeding can occur, intravenous erythromycin, amphotericin, mitomycin, etc., gastrointestinal symptoms can also occur, occasionally gastrointestinal bleeding, polymyxin It is highly toxic to gastric epithelial cells, which can cause ischemia of gastric mucosa, promote the release of histamine, and form gastritis and gastric mucosal damage.
3. Anti-tumor drugs
Such as methotrexate, 6-mercaptopurine, 5-fluorouracil, etc., stimulate the gastrointestinal mucosa to produce diffuse inflammation, mucosal swelling, erosion or ulceration, etc., nausea, vomiting, anorexia symptoms, gastritis or gastric ulcer.
4. Adrenal corticosteroids
Including ACTH, a variety of glucocorticoids, can induce gastrointestinal ulcers, or ulcer recurrence, worsening, Boland reported to treat rheumatoid arthritis with prednisone, the incidence of peptic ulcer up to 37%, caused by adrenocortical hormone Gastrointestinal ulcers, also known as steroid ulcers (Steroid Ulcer), clinical symptoms are slightly different from general peptic ulcers, pain has no obvious regularity, often occurs in insidious attacks, the lesions are already very serious, even bleeding, perforation is It is found that this is due to the increase in the pain threshold and the decrease of the inflammatory response. Therefore, the gastrointestinal reaction should be closely observed before and during the treatment, especially in the original ulcers, and more corticosteroids should be used. Should avoid the use of salicylate, antipyretic analgesics and anti-drugs, should not drink alcohol during the medication, should be given high protein, high vitamin and ulcer disease diet, if necessary, can be combined with acid, anti-ulcer drugs.
5. Other drugs
Sympathetic blockers such as antihypertensive drugs, sputum ethoxide, etc. can promote gastric acid secretion, increase gastrointestinal motility, and prone to gastric ulcer, phentolamine, phenol oxazoline, etc., have a histamine-like effect, can aggravate the stomach Ulcer symptoms, histamine drugs stimulate gastric acid, pepsin secretion, often used to cause ulcer disease or increase the original ulcer disease, oral hypoglycemic agents such as metobutamide, insulin injection, can increase gastric secretion, gastric acid increase , and easy to produce ulcer disease, it is an H1-receptor agonist, which stimulates gastric acid secretion and aggravates gastric ulcer. In addition, high-dose application of niacin and vitamin B6 can promote histamine release; Caffeine, thyroxine, ammonia tea, estrogen, captopril, etc., all cause stomach symptoms, promote the formation of gastric ulcer and the possibility of bleeding.
Examine
Examination of drug-induced stomach diseases
1, fiber gastroscopy, visible gastric mucosa extensive congestion, multiple erosions, bleeding points, superficial ulcers, sometimes see active oozing in the stomach.
2, tissue biopsy, often inflammatory cell infiltration, superficial mucosal necrosis, bleeding and so on.
Diagnosis
Diagnosis and identification of drug-induced gastric diseases
According to the medical history, clinical manifestations and laboratory data is not difficult to make a diagnosis.
Mainly with non-drug esophagitis, gastric and duodenal lesions, peptic ulcer, gastric cancer, gastric mucosal prolapse, non-ulcerative dyspepsia and other identification.
