High-dose ibuprofen therapy associated with esophageal ulceration after pneumonectomy in a patient with cystic fibrosis: a case report

BMC Pediatrics

Ran D Anbar¹  Jennifer E Mackey¹ 

[1]Department of Pediatrics, University Hospital, State University of New York Upstate Medical University, Syracuse, NY, USA

关键词: pneumonectomy;    ibuprofen;    gastrointestinal bleed;    esophageal ulceration;    cystic fibrosis;   

Others  :  1181706
DOI  :  10.1186/1471-2431-4-19

 received in 2004-05-26, accepted in 2004-09-13,  发布年份 2004

【 摘 要 】

Background

Lung disease in patients with cystic fibrosis is thought to develop as a result of airway inflammation, infection, and obstruction. Pulmonary therapies for cystic fibrosis that reduce airway inflammation include corticosteroids, rhDNase, antibiotics, and high-dose ibuprofen. Despite evidence that high-dose ibuprofen slows the progression of lung disease in patients with cystic fibrosis, many clinicians have chosen not to use this therapy because of concerns regarding potential side effects, especially gastrointestinal bleeding. However, studies have shown a low incidence of gastrointestinal ulceration and bleeding in patients with cystic fibrosis who have been treated with high-dose ibuprofen.

Case presentation

The described case illustrates a life-threatening upper gastrointestinal bleed that may have resulted from high-dose ibuprofen therapy in a patient with CF who had undergone a pneumonectomy. Mediastinal shift post-pneumonectomy distorted the patient's esophageal anatomy and may have caused decreased esophageal motility, which led to prolonged contact of the ibuprofen with the esophagus. The concentrated effect of the ibuprofen, as well as its systemic effects, probably contributed to the occurrence of the bleed in this patient.

Conclusions

This report demonstrates that gastrointestinal tract anatomical abnormalities or dysmotility may be contraindications for therapy with high-dose ibuprofen in patients with cystic fibrosis.

【 授权许可】

   
2004 Mackey and Anbar; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Oermann CM: Anti-inflammatory approaches to the treatment of cystic fibrosis lung disease: Past, present and future. Current Opinion in Investigational Drugs 2001, 2:900-906.
• [2]Chmiel JF, Berger M, Konstan MW: The role of inflammation in the pathophysiology of CF lung disease. Clinical Reviews in Allergy and Immunology 2002, 23:5-27.
• [3]Kennedy MJ: Inflammation and cystic fibrosis pulmonary disease. Pharmacotherapy 2001, 21:593-603.
• [4]Nguyen T, Louie SG, Beringer PM, Gill MA: Potential role of macrolide antibiotics in the management of cystic fibrosis lung disease. Current Opinion in Pulmonary Medicine 2002, 8:521-528.
• [5]Gibson RL, Emerson J, McNamara S, Burns JL, Rosenfeld M, Yunker A, Hamblett N, Accurso F, Dovey M, Hiatt P, Konstan MW, Moss R, Retsch-Bogart G, Wagener J, Waltz D, Wilmott R, Zeitlin PL, Ramsey B: Significant microbiological effect of inhaled tobramycin in young children with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2003, 167:841-849.
• [6]Equi A, Balfour-Lynn IM, Bush A, Rosenthal M: Long term azithromycin in children with cystic fibrosis: a randomised, placebo-controlled crossover trial. Lancet 2002, 360:978-984.
• [7]Konstan MW, Krenicky JE, Finney MR, Kirchner HL, Hillard KA, Hillard JB, Davis PB, Hoppel CL: Effect of ibuprofen on neutrophil migration in vivo in cystic fibrosis and healthy subjects. The Journal of Pharmacology and Experimental Therapeutics 2003, 306:1086-1091.
• [8]Konstan MW, Byard PJ, Hoppel CH, Davis PB: Effect of high-dose ibuprofen in patients with cystic fibrosis. New England Journal of Medicine 1995, 332:848-853.
• [9]Kopec SE, Irwin RS, Umali-Torres CB, Balikian JP, Conlan AA: The postpneumonectomy state. Chest 1998, 114:1158-1184.
• [10]Rasch DK, Grover FL, Schnapf BM, Clarke E, Pollard TG: Right pneumonectomy syndrome in infancy treated with an expandable prosthesis. The Annals of Thoracic Surgery 1990, 50:127-129.
• [11]Eren S, Eren MN, Balci AE: Pneumonectomy in children for destroyed lung and the long-term consequences. The Journal of Thoracic and Cardiovascular Surgery 2003, 126:574-581.
• [12]Cryer B: Mucosal defense and repair: Role of prostaglandins in the stomach and duodenum. Gastroenterology Clinics of North America 2001, 30:877-894.
• [13]Reichard KW, Vincour CD, Franco M, Crisci KL, Flick JA, Billmire DF, Schidlow DV, Weintraub WH: Fibrosing colonopathy in children with cystic fibrosis. Journal of Pediatric Surgery 1997, 32:237-242.
• [14]Schibli S, Durie PR, Tullis ED: Proper usage of pancreatic enzymes. Current Opinion in Pulmonary Medicine 2002, 8:542-546.
• [15]Cystic Fibrosis Foundation Patient Registry: Annual Data Report to the Center Directors. Bethesda, Maryland 2002.
• [16]Oermann CM, Sockrider MM, Konstan MW: The use of anti-inflammatory medications in cystic fibrosis. Chest 1999, 115:1053-1058.
• [17]Kovesi TA, Swartz R, MacDonald N: Transient renal failure due to simultaneous ibuprofen and aminoglycoside therapy in children with cystic fibrosis. New England Journal of Medicine 1998, 338:65-66.
• [18]Konstan MW, Hoppel CL, Chai B, Davis PB: Ibuprofen in children with cystic fibrosis: pharmacokinetics and adverse effects. Journal of Pediatrics 1991, 118:956-964.
• [19]Konstan MW, Schluchter MD, Storfer-Isser A, Davis PB: Use of ibuprofen for the treatment of airway inflammation in CF: an update. Pediatric Pulmonology 2002, 34(suppl 24):164-165.
• [20]Oermann CM, Sockrider MM, Murry DJ: One year's experience with high-dose ibuprofen therapy in CF [abstract]. Pediatric Pulmonology 1996, 22(suppl 13):280-281.
• [21]Bell EA, Grothe R, Zivkovich V, Foote JM, Wellendorf J: Pyloric channel stricture secondary to high-dose ibuprofen therapy in a patient with cystic fibrosis. The Annals of Pharmacotherapy 1999, 33:693-696.