Beware of NSAID abuse: think twice before operating!

摘要

In the past year we have managed five patients with unrecognized non-steroidal anti-inflammatory drugs (NSAID) abuse referred to us with non-healing gastric ulcers. With the increasing use of over-the-counter NSAIDs, surgeons are increasingly likely to encounter this problem. Tablets containing NSAID and codeine combinations are abused for their opioid effects. Patients presented with upper gastrointestinal complications caused by abuse of NSAID-codeine drugs. Presentations were with non-healing gastric ulcers with or without perforation, or gastric outlet obstruction. Four patients did not volunteer NSAID use until confronted with positive NSAID urine tests. All patients were young and had chronic pain. Complicated ulcers were diagnosed endoscopically, and complex issues during recovery followed surgical intervention. Early recognition of abuse is crucial as surgery may be avoidable, and ulcers can heal once NSAIDs are stopped. Furthermore, surgical intervention may be futile if abuse is not recognized, as ulcer-related problems can recur after surgery. In an era of effective medical therapy, failure of benign ulcers to heal should raise suspicion of NSAID abuse.