1. Coordinator: Dr. Anca Negovan Author: Andreea Bianca Stoica Co-authors: Drd. Monica Pantea Adrian Stoica Roxana Spac Gavriela Radoiu

2. INTRODUCTION Non-steroidal anti-inflammatory drugs (NSAID) and low-dose aspirin (LDA) are well known to cause gastrointestinal mucosal injury. The gastrointestinal side effects of NSAIDs and antiplatelet therapy are important causes of patients’ addressability to the gastroenterologist in a population with a high prevalence of Helicobacter pylori infection.

3. Background Low-dose aspirin (ASA) is frequently used in primary and secondary prevention of cardio-vascular and cerebro-vascular events due to the clinical evidence of benefits in decreasing mortality. Long term treatment has some benefits such as reducing myocardial infarction, cerebro-vascular events and death caused by vascular disease, but it also has disadvantages: it can cause a higher prevalence of endoscopic upper gastrointestinal lesions. Kim C, et al. Am J Prev Med 2004 Pirmohamed M, BMJ 2004, 329:15-19

4. THE AIM To determine the prevalence and severity of endoscopic upper gastrointestinal lesions in patients taking low-dose aspirin and non-aspirin non-steroidal anti-inflammatory drugs in a population with a high prevalence of H. pylori infection

5. METHODS (1) We perform a longitudinal descriptive study of upper gastrointestinal endoscopy and medical records (including medication) in patients referred for endoscopy in III-rd Medical Clinic Targu-Mures during a period of three years (2011-2013). We matched patients who were taking NSAIDs (n=111), aspirin (226) with control patients (n=750) who were reportedly not taking any of these medications

6. METHODS (2) Including criteria were: patients referred for UDE presenting dyspeptic symptoms (heartburn, abdominal pain, vomiting), melaena, haematemesis, unexplained anemia or patients evaluated for unexplained weight loss, or evaluated before cardiac surgery. Excluding criteria were: portal hypertension, Mallory- Weiss tears, neoplastic lesions, therapeutic maneuver, alcohol intake more than 20U weekly.

7. METHODS (3) We recorded details of patients demography, digestive complaints, clinical observations, drug intake The UDE database was reviewed to ascertain endoscopic findings which were categorized as ulcers (gastric or duodenal), gastritis (erosive or non-erosive);

8. RESULTS A total number of 1421 patients, 740 men and 681 women (mean age 60,6 years) were referred for UDE because symptoms (heartburn, pain), bleeding signs, unexplained anemia or weight loss and pre-surgery clinical evaluation during 3 years. The patients were classified into three groups based on current exposure to medications of interest: ASA=aspirin, NSAIDs=non-steroidal anti-inflammatory drugs and control group.

9. RESULTS The most frequent NSAIDs used were diclofenac and ketoprofen. Low-dose aspirin represented 75 or 100 or 125 mg daily. We excluded patients taking combinations of these.

10. Demographical characteristics of studied group

12. SYMPTOMS NSAIDs group N=111 pASA group N=226 pControl group N=750 Epigastric pain 65,7%0,0245,1%0,02054% Heartburn37,8%0,0521,2%0,0328,5% Nausea/vom iting 23,4%0,0714,6%0,616% Melaena8,1%0,064,4%0,73,7 % Anemia35,1%<0,0001 16,3%0,2 13,3%

13. Endoscopic findings NSAIDs group N=111 pASA group N=226 pControl group N=750 Gastric and/or duodenal ulcers 17,1%0,0212,3%0,29,4% Bleeding signs18,%0,0088,8%0,67,7% Erosive gastritis24,3%<0,000123,4%<0,000110,2%

14. Histological aspects NSAIDs group N=111 ASA group N=226 Control group N=750 H. pylori infection44,1%; p=0,0134%; p=0,632,2% Chronic gastritis23,4%21,6%22,6% Gastric atrophy/intestinal metaplasia 9,9%; p=0,0220,3%; p=0,719%

15. CONCLUSION Long-term therapy with aspirin is very frequent in patients referred for endoscopic evaluation, but the patients have less frequent digestive symptoms. Patients treated with NSAID therapy have more frequent digestive symptoms and anemia comparative with patients not taking gastrotoxic medication. Gastrointestinal toxicity was higher in patients taking NSAID who presented more frequent ulcer and bleeding signs on endoscopy, possibly correlated with high prevalence of H. pylori infection in this group. The aspirin consumers do not have in our population more severe endoscopic lesions than control group, may due to selection criteria (patients screened before surgery without symptoms)

16. Thank you for your attention!