Title: Pill Induced GI Bleed in a Case Rheumatoid Arthritis
Authors: Smit Uttam Janrao, Dr Sapna Anjutagi, Dr Pramod Umarji, Dr Bhavin Davra
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.50
Abstract
A 60 year old female presented to our hospital with chief complaints of generalised weakness and passage of black coloured stools. She was known case of Rheumatoid arthritis diagnosed outside and was on treatment with hydroxychloroquine and prednisolone. Workup for gastrointestinal bleeding was done and OGD scopy revealed evidence of erosive esophagitis, gastritis with duodenitis. On basis of this report cause of GI bleed was found to be Pill induced and offending agent i.e. steroid was stopped and patient responded well after stopping steroid. Steroid was responsible for her GI bleed. One should always keep this drug history as Pill esophagitis can convert into worst prognosis.
Keywords: Pill esophagitis, GI bleed, prednisolone, rheumatoid arthritis.
References
1. Malaviya AN, Kapoor SK, Singh RR,et al.Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int 1993;131-4
2. Jasvinder A.Singh et al.2015 American college of Rheumatology Guidelines for the Treatment of Rheumatoid Arthritis;4-20
3. Longstreth GF. Epidemiology of hospitali-zation for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90(2):206-210
4. Curtis JR, Xie F, Chen L, et al. The incidence of gastrointestinal perforations among rheumatoid arthritis patients. Arthritis Rheum. 2011;63:346–351.
5. Piper JM, Ray WA, Daugherty JR, Griffin MR. Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflamm-atory drugs. Ann Intern Med. 1991; 114:735–740.
6. Aalykke C, Lauritsen K. Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol. 2001;15:705–722.
7. Conn HO, Blitzer BL. Nonassociation of adrenocorticosteroid therapy and peptic ulcer. N Engl J Med. 1976;294:473–479.
8. Guslandi M, Tittobello A. Steroid ulcers: a myth revisited. BMJ. 1992;304:655–6569. Carpani de Kaski M, Rentsch R, Levi S, Hodgson HJ. Corticosteroids reduce regenerative repair of epithelium in experimental gastric ulcers. Gut. 1995;37: 613–616. ]
9. Luo JC, Shin VY, Liu ES, So WH, Ye YN, Chang FY, Cho CH. Non-ulcerogenic dose of dexamethasone delays gastric ulcer healing in rats. J Pharmacol Exp Ther. 2003;307:692–698]
10. Luo JC, Shin VY, Liu ES, Ye YN, Wu WK, So WH, Chang FY, Cho CH. Dexamethasone delays ulcer healing by inhibition of angiogenesis in rat stomachs. Eur J Pharmacol. 2004;485: 275–281. ]
11. Gary S.Firestein,Ralph Budd .Kelly’s Textbook of Rheumatology 9th ed;Elsevier-Saunders,2013;910.
12. Massó González EL, Patrignani P, Tacconelli S, García Rodríguez LA. Variability among nonsteroidal antiinflammatory drugs in risk of upper gastrointestinal bleeding. Arthritis Rheum. 201ss0;62(6):1592-1601.
13. Barkun AN, Bardou M, Kuipers EJ, et al.; International Consensus Upper Gastroint-estinal Bleeding Conference Group. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal blee-ding. Ann Intern Med. 2010;152(2): 101-113.