Overview
Injury to the gastrointestinal tract can result from various causes, including NSAID use and caustic substance ingestion, leading to significant morbidity and potential mortality.Diagnosis
NSAID-induced injury: Clinical suspicion based on patient history and symptoms; endoscopic evaluation may be necessary for confirmation 1.
Caustic ingestion: Historically, endoscopy was the gold standard, but recent evidence supports computed tomography (CT) scan as a first-line investigation for accurate diagnosis of necrosis and guiding surgical decisions 2.Management
NSAID-induced injury: Consider prophylactic use of rebamipide in combination with NSAIDs to potentially reduce lower gastrointestinal tract injury 1.
Caustic ingestion: CT scan recommended as initial imaging to assess injury severity and predict outcomes such as stricture formation; endoscopic evaluation may still be needed in selected cases 2.Special Populations
No specific recommendations provided for pregnancy, pediatrics, elderly, or comorbidities based on the given abstracts.Key Recommendations
Consider the prophylactic use of rebamipide in patients at risk of NSAID-induced lower gastrointestinal tract injury to potentially mitigate injury (Evidence: Moderate 1).
Utilize computed tomography (CT) scan as the first-line imaging modality in assessing caustic ingestion cases to guide management and predict outcomes (Evidence: Moderate 2).
Evaluate the necessity of endoscopy on a case-by-case basis following CT scan in caustic ingestion patients, rather than as an initial standard procedure (Evidence: Expert opinion 2).References
1 Imai T, Hazama K, Kosuge Y, Suzuki S, Ootsuka S. Preventive effect of rebamipide on NSAID-induced lower gastrointestinal tract injury using FAERS and JADER. Scientific reports 2022. link
2 Gill M, Tee D, Chinnaratha MA. Caustic ingestion: Has the role of the gastroenterologist burnt out?. Emergency medicine Australasia : EMA 2019. link