今天被老闆(也不算狠狠地)指導了一下：NSAID若會引起上腹痛，多為gastric ulcer。若像H2 blocker(還是應該要有做胃鏡才能用@@)或是Strocain(居然含有少量的麻醉劑，但也有含有抗脹氣)不適合與NSAID併用，來緩解其副作用。反倒是應該是讓病人去做胃鏡或是自費買PPI使用才行！
在這個學習之中，其實有幾個重點：
1. NSAID引起的peptic ulcer的位置其實為GU，並非DU。
(以下引用一篇近期文章)
Unlike H2-blockers, PPIs protect from non-steroidal anti-inflammatory drug-injury not only the duodenum, but also the stomach, where the majority of mucosal lesions are usually located.
(註)
Ital J Gastroenterol Hepatol. 1999;31 Suppl 1:S63-72.
Prevention and treatment of non-steroidal anti-inflammatory drug-induced gastro-duodenal damage: rationale for the use of antisecretory compounds.
Scarpignato C, Pelosini I.
2. H2 blocker在NSAID-induced ulcer的角色。雖然說PPI比較好，但H2 blocker最近出現逆襲，居然出了「DUEXIS (Ibuprofen + Famotidine)」，暈，所以有效??
(註)
Expert Rev Gastroenterol Hepatol. 2012 Feb;6(1):25-35. doi: 10.1586/egh.11.88.
HZT-501 (DUEXIS(®); ibuprofen 800 mg/famotidine 26.6 mg) gastrointestinal protection in the treatment of the signs and symptoms of rheumatoid arthritis and osteoarthritis.
Schiff M, Peura D.
Source
Division of Rheumatology, University of Colorado School of Medicine, Denver, CO, USA. lmschiff@aol.com
3. Strocain含有局部麻醉劑→可能會引起painless perforated peptic ulcer (沒有查到相關資料，但用推論方法可以成立@@)
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