Endoscopic findings in children on non-steroidal anti-inflammatory drugs NSAIDs

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) remain as the initial approach to the pharmacologic management in juvenile rheumatoid arthritis (JRA). Gastrointestinal (GI) damage associated with NSAIDs is common in adults, but there are few studies available in children. This study was performed to determine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Methods: Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinically and by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, southern Iran from June 1999 to June 2003.. Results: The mean age of the patients was 9.8 years (11 females), and the mean duration under NSAIDs management was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in 42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant difference between the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopic endoscopic lesions were found in 85.7% and infection of Helicobacter pylori (Hp) in 14.3% of cases. There was no significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Conclusions: Our data showed that patients using NSAIDs had frequent GI damage without any relationship to the duration of treatment. There were also a high number of children with GI damage and without any clinical complaint. Furthermore, we found no significant relationship between the duration of drug use and the GI complaints, and no relation between duration and GI complaints to upper GI tract endoscopic lesions. The possibility of GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and prevention measures are suggested.