From the Guidelines
For patients with pericarditis and chronic gastritis, ibuprofen (600 mg every 8 hours) is the preferred NSAID, as it has a lower risk of gastrointestinal complications compared to aspirin, and should be used with gastric protection, such as a proton pump inhibitor like omeprazole 20-40 mg daily or pantoprazole 40 mg daily, as recommended by the 2015 ESC guidelines 1. The treatment duration typically ranges from 1-2 weeks at full dose, followed by a gradual taper over 2-4 weeks based on symptom resolution and normalization of inflammatory markers. Some key points to consider in the management of pericarditis with chronic gastritis include:
- The use of gastric protection to minimize the risk of gastrointestinal complications, as NSAIDs can increase this risk, especially in patients with a history of gastritis 1.
- The selection of an NSAID that matches the patient's specific needs and risk factors, as different NSAIDs have varying levels of ulcerogenic risk, as noted in studies on NSAID-induced gastrointestinal complications 1.
- The consideration of colchicine (0.5-0.6 mg once or twice daily) combined with lower-dose NSAIDs for patients with very high gastric risk, as an alternative approach to minimize gastrointestinal complications, as suggested by the 2015 ESC guidelines 1.
- The potential use of corticosteroids like prednisone (0.25-0.5 mg/kg/day) in cases where NSAIDs are absolutely contraindicated, although they are generally reserved for refractory cases due to higher recurrence risk, as noted in the guidelines 1. It is essential to weigh the benefits and risks of each treatment option and to consider the individual patient's needs and risk factors when selecting an NSAID for the treatment of pericarditis with chronic gastritis, as emphasized in the guidelines and studies on NSAID use and gastrointestinal complications 1.
From the Research
Treatment of Pericarditis with NSAIDs in Patients with Chronic Gastritis
- The treatment of pericarditis with NSAIDs in patients with chronic gastritis requires careful consideration of the gastrointestinal risks associated with NSAID use 2.
- Patients with a history of ulcer or ulcer complication, advanced age, or those receiving concurrent aspirin, anticoagulants, or corticosteroid therapy are at higher risk for gastrointestinal complications with traditional NSAIDs 2.
- The use of a proton pump inhibitor (PPI) in combination with an NSAID can reduce the risk of gastrointestinal complications, including dyspeptic symptoms and ulcer bleeding 2, 3.
- Celecoxib, a COX-2 selective inhibitor, has been shown to be effective in reducing the risk of recurrent upper gastrointestinal bleeding in patients at high risk for gastrointestinal events, including those with chronic gastritis 3.
- However, the use of a COX-2 inhibitor plus a PPI may not provide additional gastrointestinal safety benefits compared to a traditional NSAID plus a PPI in high-risk patients 4.
- Etoricoxib, another COX-2 inhibitor, has been shown to be safe and effective in patients with inflammatory bowel disease, with no significant increase in disease activity or gastrointestinal complications 5.
- A study comparing hospitalization rates for gastrointestinal events between users of traditional NSAIDs plus PPIs and COX-2 inhibitors found that COX-2 inhibitors were associated with a lower risk of hospitalization for gastrointestinal events, particularly among acute users 6.
NSAID Options for Pericarditis Treatment
- Celecoxib may be a suitable option for patients with pericarditis and chronic gastritis, given its efficacy in reducing gastrointestinal risks 3.
- Naproxen, a traditional NSAID, may not be the best option for patients with chronic gastritis, as it has been associated with a higher risk of gastrointestinal complications compared to celecoxib 3.
- Etoricoxib may also be considered as an alternative to traditional NSAIDs, given its safety profile in patients with inflammatory bowel disease 5.