Emmanuel J H, Montgomery R D
Postgrad Med J. 1971 Apr;47(546):227-32. doi: 10.1136/pgmj.47.546.227.
Sixteen cases are described of gastric ulcer in patients receiving anti-arthritic drugs. Half of the ulcers were in the antrum or on the greater curve. Ten patients were under treatment with indomethacin and/or prednisone, seven of them receiving both drugs. The ulcers healed readily when the drugs were withdrawn, and in the case of prednisone a continued daily dose of 10 mg or less did not prevent healing. All the patients with haemorrhage were taking aspirin, with or without other drugs. The literature is reviewed, and it is suggested that the increased incidence of peptic ulcer in patients receiving anti-arthritic drugs is confined to gastric ulcer. There is suggestive evidence of an increased susceptibility to antral ulcer in severe rheumatoid disease, which may largely account for the ‘steroid ulcer’. Indomethacin is potentially ulcerogenic, and its combined use with steroids may be inadvisable. Apart from its tendency to produce haemorrhagic erosions, the role of aspirin in the aetiology of chronic ulcer remains doubtful. No serious ill-effects have been reported in the use of ibuprofen or Distalgesic in ulcer subjects.
本文描述了16例接受抗关节炎药物治疗的患者发生胃溃疡的情况。其中一半的溃疡位于胃窦或大弯侧。10例患者正在接受吲哚美辛和/或泼尼松治疗，其中7例同时服用这两种药物。停药后溃疡很容易愈合，对于泼尼松而言，持续每日剂量10毫克或更低并不妨碍愈合。所有出血患者均服用了阿司匹林，无论是否同时服用其他药物。本文对相关文献进行了综述，并指出接受抗关节炎药物治疗的患者消化性溃疡发病率增加仅限于胃溃疡。有提示性证据表明，严重类风湿病患者发生胃窦溃疡的易感性增加，这可能是“类固醇溃疡”的主要原因。吲哚美辛有潜在的致溃疡作用，将其与类固醇联合使用可能不可取。除了有产生出血性糜烂的倾向外，阿司匹林在慢性溃疡病因学中的作用仍存疑问。在溃疡患者中使用布洛芬或痛力克未报告有严重不良反应。
