HISTOPATHOLOGICAL ASPECTS OF MUCOSAL INJURY RELATED TO NONSTEROIDAL ANTIINFLAMMATORY DRUGS

As the majority of patients with chronic arthritis are treated, for ma ny years, with non-steroidal anti-inflammatory drugs (NSAID), it is on ly natural to expect the long-term use of these agents to be associate d with a range of oesophago-gastro-duodenal histopathological changes. We have demonstrated that oesophagitis (defined on basis of papillary length, basal cell hyperplasia and inflammatory cell infiltration) is less prevalent in patients taking NSAID. This phenomenon can be utili sed in the treatment of certain conditions such as post-irradation oes ophagitis and Barrett's oesophagitis. It also implies that NSAID-relat ed oesophageal ulceration is due to lodging of tablets in the oesophag us and is, in turn, preventable by swallowing of some fluids or solids after taking NSAID, In the stomach, long-term use of NSAID is associa ted with a specific entity known as chemical or reactive gastritis in about 25% of cases, This is frequently associated with ulceration. Chr onic active superficial gastritis, in the presence of Helicobacter pyl ori, call be found in about 70% of cases. Not unlike oesophagitis, the prevalence of active duodenitis is low in chronic NSAID users. Local ulceration still takes place. This implies that duodenitis is not requ ired in at least some cases of NSAID-related duodenal ulcers, and demo nstrates the multi-factorial nature of the pathogenesis of mucosal dam age in long-term users of a NSAID.