NSAID-GASTRITIS

Q.) In NSAID-associated ulceration true are-

a. Adverse effects from NSAIDs are rare
b. Prostaglandins (PGE2 and PGI2) increase gastric acid secretion
c. Eradication of Helicobacter pylori will reduce the risk of NSAID-induced bleeding
d. Ibuprofen is less likely to cause serious gastrointestinal side effects than diclofenac.

Ans: D.

Adverse effects from NSAIDs (non-steroidal anti-inflammatory drugs) are common, especially as they are often given for long periods of time to elderly patients. NSAIDs inhibit cyclooxygenase and decrease the production of prostaglandins, which are protective, via a decrease in gastric acid secretion. Although eradicating H. pylori may help reduce the overall risk of ulceration in those starting long-term NSAID treatment that have dyspepsia or a history of ulceration, it is unlikely to reduce the risk of NSAID-induced bleeding or ulceration in those already on NSAIDs. Ibuprofen is the NSAID associated with the lowest risk of bleeding.


Important : 

Inhibition of Gastric Secretion:

Although intestinal chyme slightly stimulates gastric secretion during the early intestinal phase of stomach secretion, it paradoxically inhibits gastric secretion at other times. This inhibition results from at least two influences. The presence of food in the small intestine initiates a reverse enterogastric reflex, transmitted through the myenteric nervous system and extrinsic sympathetic and vagus nerves, that inhibits stomach secretion. This reflex can be initiated by distending the small bowel, by the presence of acid in the upper intestine, by the presence of protein breakdown products, or by irritation of the mucosa. This is part of the complex mechanism discussed in Chapter 63 for slowing stomach emptying when the intestines are already filled. The presence of acid, fat, protein breakdown products, hyperosmotic or hypo-osmotic fluids, or any irritating factor in the upper small intestine causes release of several intestinal hormones. One of these is secretin, which is especially important for control of pancreatic secretion. However, secretin opposes stomach secretion. Three other hormones-gastric inhibitory peptide (glucose-dependent insulinotropic peptide), vasoactive intestinal polypeptide, and somatostatin-also have slight to moderate effects in inhibiting gastric secretion PGE2,PGI2 both inhibit acid secretion.  source: Guyton textbook of physiology