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

Non-steroidal anti-inflammatory drugs (NSAIDs) remain as the initial approach to thepharmacologic management in juvenile rheumatoid arthritis (JRA). Gastrointestinal (GI) damage associated withNSAIDs is common in adults, but there are few studies available in children. This study was performed todetermine the GI complications due to the use of NSAIDs in a cohort of JRA patients by endoscopy. Twenty-one patients with JRA who were using NSAIDs for at least 3 months were assessed clinicallyand by endoscopy at Pediatric Immunology Clinic of Nemazee Hospital affiliated to Shiraz University of MedicalSciences in Shiraz, southern Iran from June 1999 to June 2003.. The mean age of the patients was 9.8 years (11 females), and the mean duration under NSAIDsmanagement was 16 months. The most common NSAIDs used was diclofenac. GI symptoms were found in42.9% of patients including 33.4% abdominal pain and 9.5% vomiting. There was no significant differencebetween the patients and symptoms free subjects in regard to mean duration of treatment. Macroscopicendoscopic lesions were found in 85.7% and infection of Helicobacter pylori (Hp) in 14.3% of cases. There wasno significant relationship between endoscopic findings and duration of treatment or clinical symptoms. Our data showed that patients using NSAIDs had frequent GI damage without any relationship tothe duration of treatment. There were also a high number of children with GI damage and without any clinicalcomplaint. 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 possibilityof GI derangements with NSAIDs in pediatric age group is high. Close monitoring of symptoms and preventionmeasures are suggested.