Early Endoscopic Gastrointestinal Changes in Osteoarthritis Patients on Long-Term NSAID Therapy and the Risk of Non-Variceal Bleeding in the Kashmiri Population. A cross sectional study

Aims The aim of this study was to examine early endoscopic signs of gastrointestinal injury in osteoarthritis patients using chronic NSAID therapy. Specifically, we aimed to understand how the duration and dosage of NSAID use relate to early mucosal changes in the gastrointestinal tract and to evaluate the potential for these early changes to predict future bleeding risks [1] [2] [3].

Methods This retrospective study reviewed medical records of osteoarthritis (OA) patients who had been on daily NSAIDs for at least six months. The study included patients aged 50 years or older, with a confirmed diagnosis of OA and a history of chronic NSAID use. We analyzed upper gastrointestinal endoscopy reports to identify early mucosal changes such as redness, erosions, and ulcers, as well as signs of active bleeding, such as fresh blood or clots. We also collected information on the type of NSAID used (selective COX-2 inhibitors vs. non-selective NSAIDs), how long the patient had been using the medication, and the daily dosage. Statistical analysis was used to determine any correlation between these factors and the endoscopic findings.

Results Of the 200 OA patients included, 120 (60%) showed early signs of gastrointestinal injury during their endoscopy. These signs included gastric redness (42%), erosions (26%), and shallow ulcers (15%). Of those with mucosal injury, 25% had active bleeding, while 75% had chronic mucosal damage without ongoing bleeding. We found that the severity of mucosal damage was significantly associated with both the length of time the patient had been using NSAIDs (mean 5.2 years) and the daily dose (p<0.01). Patients using non-selective NSAIDs were more likely to experience erosions and ulcers compared to those using selective COX-2 inhibitors (p<0.05). Moreover, 18% of patients with early mucosal changes went on to develop significant gastrointestinal bleeding within 12 months.

Conclusions Long-term NSAID use in OA patients is linked to early endoscopic signs of gastrointestinal damage, even in the absence of visible bleeding. These early changes, such as redness and erosions, can indicate an increased risk for future bleeding events. Monitoring OA patients on chronic NSAID therapy for these early signs could help reduce the risk of severe gastrointestinal bleeding. Switching to selective COX-2 inhibitors may be a safer option for long-term pain management in high-risk patients

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Andrew Moore R.. Endoscopic ulcers as a surrogate marker of NSAID-induced mucosal damage. Arthritis Res Ther 2013; 15 (Suppl 3) S4
• 2 Sohail R, Mathew M, Patel KK, Reddy SA, Haider Z, Naria M, Habib A, Abdin ZU, Razzaq Chaudhry W, Akbar A.. Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review. Cureus. 2023; 15 (4): e37080
• 3 Rotondano G.. Epidemiology and diagnosis of acute nonvariceal upper gastrointestinal bleeding Gastroenterol Clin North Am.

Publication History

Article published online:
27 March 2025