Effectiveness comparison of endoscopic methods of non-varicose upper gastrointestinal bleeding treatment

Introduction

In every case of upper gastrointestinal bleeding suspicion, an endoscopic examination ought to be performed as a matter of urgency. Finding active bleeding, a visible non-bleeding vessel or a lesion with an adherent clot should be followed by application of an available method of endoscopic therapy. The aim of the study was to compare the effectiveness of various endoscopic treatment techniques such as epinephrine injections, coagulation methods and mechanical methods in the treatment of non-varicose upper gastrointestinal bleeding.

Material and methods

Sixty cases of non-varicose upper gastrointestinal bleeding were analysed in terms of the effectiveness of the above-mentioned procedures used in monotherapy or in combination therapy comprising epinephrine injections and clips application. The choice of the applied procedure depended on morphological features and location of the bleeding source, the patient''s general condition, as well as technical equipment and manual skills of the endoscopy staff.

Results

The study confirmed the effectiveness of endoscopic treatment of non-varicose upper gastrointestinal bleeding applying the above-mentioned methods. In most patients, this treatment enabled traumatic surgical intervention to be avoided; it was required in only 3 (5%) out of 60 patients with confirmed upper gastrointestinal bleeding. With the first endoscopy, haemostasis was achieved in 47 cases (78.3%) and the second endoscopy, performed due to bleeding recurrence, was successful in the remaining 10 cases (16.7%).

Conclusions

In non-varicose upper gastrointestinal bleeding, urgent diagnostic and therapeutic endoscopy should be the first-line management. If the lesion that is the source of bleeding is possible to localize, the endoscopic techniques should be applied. Among the endoscopic procedures used in monotherapy, clips appeared to be the most effective, their effectiveness being comparable to combination therapy. In bleeding from extensive lesions, coagulation methods are considered to be the most efficacious.     

Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital,northern Uganda

Background

Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions.

Objective

To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda.

Methods

The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed.

Results

A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB

Conclusions

Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease.     

Pyogenic granuloma of the large intestine: Case report and review of reported cases in the adult

Pyogenic granuloma (PG) is a polypoid lobular capillary hemangioma rarely described in the large bowel. We describe the case of a 72-year-old man with recent weight loss, anemia, and change in bowel habit. A 3 cm × 2 cm polypoid lesion in the right flexure of the colon was observed and treated with extended right hemicolectomy. A review of the English-language literature on PG of the large bowel in adults yielded eight previously reported cases. The age of the patients ranged from 26 to 80 years with a mean of 54.8 years. The lesions were all solitary, except one case of multiple lesions in the colon. Another case was associated with satellite lesions. Seven cases were located in the colon and two in the rectum. The mean maximum diameter of the lesions was 1.6 cm (range 0.5–3 cm). Colorectal bleeding was the most common clinical symptom. Due to its unusual appearance, PG can be misdiagnosed and mistreated as colon carcinoma with extensive surgery. Polypectomy or endoscopy mucosal resection is the optimal treatment. In large or deep lesions, a surgical excision may be necessary. Pathologists should be familiar with this condition so as to avoid overdiagnosis as a malignant vascular tumor.     

The visible vessel as an indicator of uncontrolled or recurrent gastrointestinal hemorrhage.

Although endoscopic examination in patients with bleeding of the upper gastrointestinal tract has improved diagnostic accuracy, it has not been useful in predicting clinical outcome and has not been shown to improve the patients' prognoses. This article describes a subgroup of patients with acute upper gastrointestinal bleeding whose clinical outcome can be predicted at the time of endoscopy. In 28 of 317 patients who underwent endoscopy, a "visible vessel" was seen in an ulcer presumed to be the bleeding site. All 28 were later recommended for operation because of recurrent (86 per cent) or uncontrolled (14 per cent) hemorrhage. In contrast, 75 per cent of the remaining 289 patients in whom vessels were not seen, whether or not bleeding from ulcers, had single bleeding episodes managed medically. Since patients with a "visible vessel" can be expected to have uncontrolled or recurrent hemorrhage, surgical treatment should be considered at the time of endoscopy if such a vessel is seen.     

Cardiac Pseudopyogenic Granuloma: A Type of Vascular Hyperplasia in the Transplanted Heart Mimicking Pyogenic Granuloma

We present a unique case of cardiac pseudopyogenic granuloma in a 61-year-old man that underwent orthotopic heart transplantation for end-stage ischemic heart disease. The lesion was an incidental pathological finding in the allograft removed for chronic graft vascular disease. This lesion is attributed to the minor trauma of the biopsy in the right side of the heart following cardiac transplantation. The cardiac right side can be considered the venous side of the heart; therefore, we consider the lesion a mimicker of an intravenous pyogenic granuloma. Pseudopyogenic granuloma may represent organization of a mural thrombus which formed secondary to biopsy procedure(s). The lesion must be distinguished from bacillary angiomatosis, Karposi sarcoma, and other neoplasms that may present an intravascular type of growth.     

Selection of hemoperfusion therapy for patients with septic shock on the basis of the primary disease

The objective of this study was to analyze retrospectively the efficacy of polymyxin-B immobilized fiber (PMX-F) alone and in combination with continuous venovenous hemofiltration (CHF) on the prognosis of critically ill patients with sepsis using a retrospective chart review in a university hospital in Japan. A cohort of 246 patients meeting the criteria of sepsis, septic shock, or both, according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/ACCM) Consensus Conference, were examined in this study. From these patients, 48 were selected who were found to have definitive causative bacteria and whose primary diseases were clearly identified. According to the charts, two major primary diseases were identified: one related to cardiovascular disease and the other to gastrointestinal disease. Other diseases were excluded from this study because of the small numbers of patients in categories such as malignant, hematological, genitourinary, and other diseases. Furthermore, patients who had levels of serum creatinine above 2.0mg/dl were excluded. The prevalence of diabetes mellitus (up to 63%) was very high in both groups. There were no significant differences between the two groups in age or the Apache II scores at the start of hemoperfusion treatment; however, the gender ratio varied: 72% of the cardiovascular group were male, compared to 46% of the gastrointestinal group. The causative bacteria were markedly different between the two groups. For half of the gastrointestinal group the causative bacterium was Escherichia coli, while for half of the cardiovascular group the causative bacterium was Pseudomonas aeruginosa.The survival rate differed significantly between the two groups. The patients in the cardiovascular group survived longer than those in the gastrointestinal group. Moreover, for the patients with cardiovascular disease, there was no significant difference in the survival rate between treatment with PMX-F alone and with PMX-F and CHF in combination. In contrast, for the patients with gastrointestinal disease, there was a significant difference between treatment with PMX-F alone and with PMX-F and CHF in combination. When a patient with sepsis or septic shock is treated with hemoperfusion, the decision as to whether PMX-F should be given alone or in combination with CHF might be determined on the basis of the primary disease of the patient.     

Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen

BACKGROUND: Many patients who have had upper gastrointestinal bleeding continue to take low-dose aspirin for cardiovascular prophylaxis or other non-steroidal antiinflammatory drugs (NSAIDs) for musculoskeletal pain. It is uncertain whether infection with Helicobacter pylori is a risk factor for bleeding in such patients. METHODS: We studied patients with a history of upper gastrointestinal bleeding who were infected with H. pylori and who were taking low-dose aspirin or other NSAIDs. We evaluated whether eradication of the infection or omeprazole treatment was more effective in preventing recurrent bleeding. We recruited patients who presented with upper gastrointestinal bleeding that was confirmed by endoscopy. Their ulcers were healed by daily treatment with 20 mg of omeprazole for eight weeks or longer. Then, those who had been taking aspirin were given 80 mg of aspirin daily, and those who had been taking other NSAIDs were given 500 mg of naproxen twice daily for six months. The patients in each group were then randomly assigned separately to receive 20 mg of omeprazole daily for six months or one week of eradication therapy, consisting of 120 mg of bismuth subcitrate, 500 mg of tetracycline, and 400 mg of metronidazole, all given four times daily, followed by placebo for six months. RESULTS: We enrolled 400 patients (250 of whom were taking aspirin and 150 of whom were taking other NSAIDs). Among those taking aspirin, the probability of recurrent bleeding during the six-month period was 1.9 percent for patients who received eradication therapy and 0.9 percent for patients who received omeprazole (absolute difference, 1.0 percent; 95 percent confidence interval for the difference, -1.9 to 3.9 percent). Among users of other NSAIDs, the probability of recurrent bleeding was 18.8 percent for patients receiving eradication therapy and 4.4 percent for those treated with omeprazole (absolute difference, 14.4 percent; 95 percent confidence interval for the difference, 4.4 to 24.4 percent; P=0.005). CONCLUSIONS: Among patients with H. pylori infection and a history of upper gastrointestinal bleeding who are taking low-dose aspirin, the eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Omeprazole is superior to the eradication of H. pylori in preventing recurrent bleeding in patients who are taking other NSAIDs.     

Human herpesvirus 8 (HHV-8) detected in two patients with Kaposi's sarcoma-like pyogenic granuloma

AIMS: To report the finding of human herpesvirus 8 (HHV-8) in two patients with Kaposi's sarcoma (KS)-like pyogenic granuloma. This form of pyogenic granuloma closely resembles KS histologically and it has been reported that immunohistochemistry in such lesions may be positive for smooth muscle actin and factor VIII related antigen, which are typically negative in KS. In both patients the lesions were positive for CD31, CD34, smooth muscle actin, and factor VIII related antigen, a profile typical of KS-like pyogenic granuloma. The lesions were tested for the presence of HHV-8 DNA, which to date has been consistently found in all types of KS. METHODS: The lesions were tested for the presence of HHV-8 DNA using the polymerase chain reaction (PCR). A known HHV-8 positive KS specimen was used as the positive control. Six samples of non-KS vascular skin lesions were used as negative controls for the PCR reaction. RESULTS: Both lesions were positive on PCR for HHV-8 and the specificity of product was confirmed by direct sequencing. None of the six control vascular skin lesions was positive for HHV-8. These results strongly indicate KS as the true diagnosis and are supported by the reported clinical course in both cases. CONCLUSIONS: Techniques targeting HHV-8 DNA for detection to confirm a diagnosis of KS are both sensitive and specific. In cases where the differential diagnosis includes KS-like pyogenic granuloma, caution should be taken not to diagnose solely on the basis of immunohistochemistry phenotype. In such cases, PCR targeting HHV-8 DNA sequences is a better diagnostic tool.     

Th1/Th2 balance in infection

Cytokines produced by T helper (Th) cells are of critical importance for the outcome of many infectious diseases. Producing the right set of Cyokines in response to an infectious agent can be a matter of life or death. The Th1/Th2 dichotomy, although an oversimplification has proven useful in the analysis of immune responses to infections. In some infectious diseases, most notably leishmaniasis or infections with gastrointestinal helminths, one Th subset is indispensable for clearing the infection, whereas the opposite Th subset is detrimental. More frequently, both Th1 and Th2 responses are required at different time points to effectively eradicate an infectious agent. The granuloma responses to eitherMycobacterium tuberculosis orSchistosoma mansoni provide illustrative examples and are discussed in this review. There is accumulating evidence for frequent coexpression of Th1 and Th2 Cyokines during the in vivo immune response to infections. The mechanisms by which infectious agents modulate Th1/Th2 phenotype development are summarized here. Finally, we review here the current evidence for cytokine imbalances induced by infections as pathogenic or protective factors in autoimmunity and allergy.     

Recurrences after Local Excision for Early Rectal Adenocarcinoma

Purpose

The role of local excision in treating rectal cancer patients continues to be controversial. The aim of this study was to evaluate the long-term oncological results of local excision for early rectal adenocarcinomas and review the outcomes of salvage therapy on rectal cancer patients.

Materials and Methods

Between March 1992 and September 2005, 35 consecutive patients with early-stage primary rectal adenocarcinomas were treated by local excision with curative intent. The mean tumor distance from the anal verge was 5 cm (range, 1-10 cm).

Results

The median follow-up was 66 months (range, 17-161 months). Pathological examination revealed 23 cases of T1 and 12 cases of T2. Recurrence had developed in 10 patients (6 local recurrences, 4 systemic recurrences). Purely extrapelvic recurrence was observed in only two (5.7%) patients. Of the eight recurrent patients with surgical salvage, five survived with no evidence of disease at the time of this analysis. The 5-year local recurrence-free and disease-free survival rates were 79.6% and 67.9%, respectively.

Conclusion

Local excision alone of early-staged rectal adenocarcinomas, even in the ideal candidate, is followed by a relatively higher local recurrence rate than previously reported and may not be a valid modality. Either the use of adjuvant therapy with local excision, even in patients with T1 lesions or the use of preoperative therapy followed by local excision has good promise.     

Comparative studies on the gastrointestinal lesions caused by several nonsteroidal anti-inflammatory agents in rats

The gastrointestinal toxicity of a single oral administration of five nonsteroidal anti-inflammatory agents (NSAIDs) to rats was compared, by a method using⁵¹Cr-labeled red blood cells (RBC), and by macroscopic and microscopic examination. From the profile of gastrointestinal bleeding, the NSAIDs could be divided into a group consisting of aspirin (ASA), oxaprozin (OXP) and 2-[4-(3-methyl-2-butenyl)phenyl]propionic acid (TA), which caused only a transient increase in fecal blood loss based on a gastric lesion, and another group including indomethacin (IM) and ibuprofen (IP), which produced a biphasic increase in the blood loss. The initial phase was caused not only by a gastric lesion but also an intestinal lesion, and the secondary phase originated only in the intestinal lesion. The order of potency causing blood loss was IMIP>ASATA>OXP. The safety ratio of OXP and TA was shown to be more favorable than that of the other three drugs.     

Treatment and clinical outcome of needle-track seeding from hepatocellular carcinoma

Background/Aims

Needle-track seeding is a rare but important complication of diagnostic and therapeutic ultrasound (US)-guided procedures in hepatocellular carcinoma (HCC). We examined the frequency of needle-track seeding after US-guided percutaneous ethanol injection (PEI), fine-needle aspiration biopsy (FNAB), and percutaneous transhepatic biliary drainage (PTBD) in order to determine the appropriate treatment for needle-track seeding and its clinical outcome.

Methods

We analyzed the clinical characteristics and treatment outcomes in eight patients who experienced needle-track seeding from HCC after an US-guided procedure (FNAB, PEI, or PTBD) between January 1990 and July 2004.

Results

Seven (0.14%) of 5,092 patients who experienced needle-track seeding (2 after PEI, 4 after FNAB, and 1 after PTBD) during the study period and 1 other patient who experienced needle-track seeding recently were recruited for this study. Two of the eight patients underwent mass excision and the other six patients underwent en-bloc wide excision for the needle-track seeding. Tumors recurred in the needle-tracks in both patients who underwent mass excision but not in the six patients who underwent en-bloc wide excision. Mortality occurred in three patients who experienced the recurrence and progression of intrahepatic HCC.

Conclusions

The incidence of needle-track seeding after US-guided procedures in HCC was 0.14%. En-bloc wide excision seems to be the optimal treatment for minimizing the probability of tumor recurrence due to needle-track seeding.     

Clinical characteristics of primary intestinal NK/T cell lymphoma,nasal type: Case series and review of the literature

Background

Primary intestinal NK/T cell lymphoma is rare but aggressive and exhibits a poor prognosis. Little is known about its clinical characteristics because few studies with small sample sizes have been reported.

Bacillus Calmette-Guérin (BCG) osteomyelitis among children: Experience in a single tertiary center in central Taiwan

BackgroundThe insidious nature of BCG-osteomyelitis makes it challenging for clinicians to detect it early on.MethodsThis 12-year retrospective analysis was conducted at a single tertiary hospital in central Taiwan. Electronic medical records of pediatric patients treated for BCG-osteomyelitis were reviewed. Demographics, clinical features, and laboratory findings were compared with patients diagnosed with culture-proven pyogenic osteomyelitis.ResultsIn total, eight patients fulfilled our inclusion criteria. Their median age was 16 months, and no obvious gender prevalence was found. Six of the eight patients had lesions involving the lower extremities. When compared with the pyogenic osteomyelitis group, age of disease onset was found to be significantly younger in the BCG osteomyelitis group (p=0.038). Absence of fever and pain in the BCG osteomyelitis group was found to be statistically significant when compared with the pyogenic group (p=0.002 and p=0.026 respectively). CRP and ESR were found to be significantly higher in the pyogenic osteomyelitis group (p=0.000 and p=0.004 respectively).ConclusionBCG-related osteomyelitis must be considered when evaluating an afebrile child presenting with an unexplainable swelling or limp, and especially when the lesion is located on a lower limb. Laboratory studies may reveal normal WBC and CRP, with a normal to modest elevation of ESR. Imaging studies, including plain radiographs, magnetic resonance imaging (MRI), or computed tomography (CT) should be employed to rule out BCG-related osteomyelitis. Early diagnosis help minimize inappropriate antibiotics use, and may lead to a better outcome.     

Fecal blood levels in health and disease. A study using HemoQuant

We tested HemoQuant, a quantitative assay of fecal blood based on the fluorescence of heme-derived porphyrin, in 106 healthy volunteers, 170 patients with gastrointestinal symptoms but with normal diagnostic studies, 44 patients with gastrointestinal cancer, 75 patients with benign polyps, and 374 patients with a variety of other benign gastrointestinal lesions, including ulcers and erosions. In 98 per cent of the healthy volunteers, fecal hemoglobin concentrations were less than 2 mg per gram of stool. Levels were similarly low in stools from patients with symptoms and normal studies and in patients with relatively minor benign lesions. Within these groups, levels were slightly higher in those who had ingested red meat or aspirin. The fecal hemoglobin concentration was higher in patients with gastrointestinal cancer than in any other group, and 97 per cent of those with colorectal cancer had levels above 2 mg per gram. The sensitivity of HemoQuant was significantly greater than that of the guaiac test Hemoccult, particularly when heme was degraded or stools were dry. Intestinal degradation of heme to porphyrin can be measured separately by HemoQuant, and was greater when bleeding was from proximal lesions rather than distal ones. We conclude that HemoQuant is a more sensitive measure of gastrointestinal bleeding than Hemoccult, and that its capacity to measure degraded heme may be useful in indicating the anatomic site of bleeding.     

Über das Xanthofibrogranulom des Retroperitoneum,der Orbita,des Mediastinum,der Lungen und der Leberwurzel und seine klinische Bedeutung

Zusammenfassung Das Xanthofibrogranulom, ein in vieler Hinsicht eigenständiger, verfettender und stark vernarbender granulomatöser Prozeß, kann im Retroperitoneum, im Mediastinum, in der Lunge, an der Leberwurzel und offenbar auch in der Orbita auftreten. Sein klinisches und pathologisch-anatomisches Verhalten liegt gewissermaßen zwischen dem eines malignen Granuloms, und dem einer chronischen Entzündung. Die endgültige Diagnose und Abgrenzung von anderen vernarbenden Prozessen ist nur durch eine histologische Untersuchung möglich. Die Ätiologie des Xanthofibrogranuloms ist noch unklar (Infektallergie?, Arzneimittelallergie?). Am häufigsten tritt es im Retroperitoneum auf, wo es am besten als Ormondsche Erkrankung zu bezeichnen wäre; hier müßte man es aber — auch aus ätiologischen und therapeutischen Gründen — von einem Ormondschen Syndrom abgrenzen, unter welchem Begriff man dann alle Fibrosen (etwa nach Entzündung, Blutungen, bei Tumoren, Myxödem u.a.U.) des Retroperitoneum zusammenfassen könnte. Die operative Therapie (Entfernung des Granuloms) ist am günstigsten für die Lunge, am ungünstigsten für das Mediastinum, während für das Retroperitoneum und die Leberwurzel palliative Operationen (Freilegung eingeengter Hohlorgane) Besserungen erzielen. Entzündungshemmende Röntgenbestrahlungen und Cortisontherapie könnten manchmal auch zu Erfolgen führen.

---

Summary The xanthofibrogranuloma is in many respects a peculiar entity consisting of a cicatrizing granuloma with xanthomatosis. It is located either in the retroperitoneal space, mediastinum, lung, at the portal fissure (liver) or, as it is presumed, also in the orbita. Its clinical and pathologicanatomical behaviour seems to be between a malignant granuloma and a cronic inflammation. The final and differential diagnosis, from other cicatrizing processes, is only possible by means of a histological examination. The etiology has not been clarified (infectious allergy? drug allergy?). Most frequently it is located in the retroperitoneal space, where it should be named Ormond's Disease. But by reasons of etiology and therapy, Ormond's Disease should be distinguished from Ormonds Syndrome, which includes all the forms of fibrosis of the retroperitoneal space (e.g. after inflammation, hemorrhages, caused by tumors or myxedema, etc.). The operative therapy has the best results when the xanthofibrogranuloma is located in the lungs and the worst results when the location is in the mediastinum; however, when the xanthofibrogranuloma infiltrates the retroperitoneal space or the portal fissure, palliative operations (treatment toward decompression of obstructed hollow organs) may offer relief to the patient. Antiphlogistic roentgen irradiation and corticosteroids have sometimes also been used with success.

     

Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage

BACKGROUND: Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain. METHODS: We studied the role of urgent colonoscopy in the diagnosis and treatment of 121 patients with severe hematochezia and diverticulosis. All patients were hospitalized, received blood transfusions as needed, and received a purge to rid the colon of clots, stool, and blood. Colonoscopy was performed within 6 to 12 hours after hospitalization or the diagnosis of hematochezia. Among the first 73 patients, those with continued diverticular bleeding underwent hemicolectomy. For the subsequent 48 patients, those requiring treatment received therapy, such as epinephrine injections or bipolar coagulation, through the colonoscope. RESULTS: Of the first 73 patients, 17 (23 percent) had definite signs of diverticular hemorrhage (active bleeding in 6, nonbleeding visible vessels in 4, and adherent clots in 7). Nine of the 17 had additional bleeding after colonoscopy, and 6 of these required hemicolectomy. Of the subsequent 48 patients, 10 (21 percent) had definite signs of diverticular hemorrhage (active bleeding in 5, nonbleeding visible vessels in 2, and adherent clots in 3). An additional 14 patients in this group (29 percent) were presumed to have diverticular bleeding because although they had no stigmata of diverticular hemorrhage, no other source of bleeding was identified. The other 24 patients (50 percent) had other identified sources of bleeding. All 10 patients with definite diverticular hemorrhage were treated endoscopically; none had recurrent bleeding or required surgery. CONCLUSIONS: Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatment of such patients with epinephrine injections, bipolar coagulation, or both may prevent recurrent bleeding and decrease the need for surgery.     

非甾体抗炎药的胃肠副作用临床分析

目的 研究非甾体抗炎药的临床胃肠副作用,为临床的良好应用提供参考依据。方法 选取2015年1月~2017年12月在我院采用非甾体抗炎药治疗的846例患者临床资料为研究对象,总结临床患者出现的胃肠副作用表现。结果 846例患者中101例发生胃肠道症状,占11.94%;5例发生胃肠道出血,占0.59%。消化道症状包括上腹不适、腹胀、腹痛、烧心、纳差、嗳气、反酸、恶心、呕吐、腹泻、便秘等;非甾体抗炎药单独使用胃肠副作用发生率低于2种非甾体抗炎药联合应用或非甾体抗炎药联用皮质激素者,差异有统计学意义（P＜0.05）;临床通过改用非甾体抗炎药或对症治疗,患者消化道症状均得到缓解,且患者可坚持用药,消化道出血患者也恢复正常,无胃肠副作用而导致的死亡。结论 临床应科学合理的控制非甾体抗炎药使用,不仅可减少严重并发症,而且可降低患者经济负担,并应尽量避免非甾体抗炎药的联合应用。