Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

AIM:To evaluate endoscopic and histopathologic aspects of acute gastric injury due to ingestion of high-dose acetaminophen and nonsteroidal antiinflammatory drugs (NSAIDs) with respect to some risk factors and patient characteristics.METHODS:The study group consists of 50 patients admitted to emergency department with high dose analgesic ingestion (group Ⅰ ) with suicidal intent.Thirty patients with or without mild complaints of dyspepsia (group Ⅱ) were selected as the control group.The study group was stratified according to the use of type and number of analgesics.Endoscopic findings were evaluated according to the Lanza score (IS),expressing the severity of the gastroduodenal damage and biopsies according to a scoring system based on histopathologic findings of acute erosive gastritis.RESULTS:Gastroduodenal damage was significantly more severe in group Ⅰ compared to group Ⅱ(P ＜ 0.01).The MS was similar in both groups Ⅰ a and I b.However LS was significantly higher in patients who had ingested multiple NSAIDs (group I c) compared to other patients (P ＜ 0.01).The MS was correlated to age (P ＜ 0.01) and total amount of drug ingested(P ＜ 0.05) in group Ⅰ ; but it was not correlated with Helicobacter pylori (H pylori) infection or duration of exposure (P ＞ 0.05).The biopsy score (BS) was higher in group Ⅰ than group Ⅱ (P ＜ 0.01),and higher in group Ⅰ b than group Ⅰ a (P ＜ 0.05).CONCLUSION:The histopathologic damage was more severe among NSAID ingesting patients compared to those ingesting only acetaminophen and there is no significant difference in the endoscopic findings between the groups.There is no significant difference in the MS between the groups.This lack of significance is remarkable in terms of the gastric effects of highdose acetaminophen.