Gastrointestinal FAQ


Frequently Asked Questions - Gastrointestinal


  1. What are the symptoms of and treatment for a GI bleed?
  2. Are GI bleeds more common or severe in PXE?
  3. Is intestinal angina related to PXE? 
  4. Does a colonoscopy have risks specific to PXE?
  5. Is it safe for someone with PXE to take ibuprofen for inflammation?
  6. Is it safe for someone with PXE to take Celebrex for inflammation?
  7. Is there a safe anti-inflammatory?
  8. Is it safe for someone with PXE to take Salsalate?
  9. Is there a pain medication that will be safe for my stomach?

1. What are the symptoms of and treatment for a GI bleed?


GI bleeding is an abbreviation for gastrointestinal bleeding. GI bleeding can have many causes from esophagitis to gastritis (inflammation in the stomach) to peptic ulcers to polyps, inflammatory bowel disease, tumors, and hemorrhoids. Those with PXE are subject to the same diseases as the general population, so any of these could develop in individuals with PXE and have nothing to do with PXE.

Gastrointestinal bleeding can be silent, producing unnoticeable blood loss that gradually leads to iron deficiency and anemia. It can also present with obvious bleeding. Bleeding from the lower GI tract (colon and rectum) presents as bright red blood in bowel movements. Bleeding from the upper GI tract (stomach, duodenum, and small intestine) can present as "melena" (black tarry bowel movements) because of the effect of gastric acid and intestinal juices on the blood. Sudden upper-GI bleeding can also be associated with vomiting blood.

Certain medications such as aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs, such as Advil, Aleve and Naprosyn) and a whole host of others, such as piroxicam (Feldene) and Relafen, can damage gastric tissues and lead to GI bleeding, either occult (not clinically visible as blood) or acute (with immediate symptoms, and requiring immediate treatment).

Upper GI bleeding, sometimes massive, has long been recognized as a symptom of PXE. It is not common, but when it occurs, it is very dramatic. The exact source can be hard to pinpoint, but it is usually from multiple small bleeding points or erosions in the stomach, but can also be from a single site. If it cannot be controlled medically, surgery is sometimes necessary to stop the bleeding. Aspirin and NSAIDs can increase the risk of bleeding, so these should be avoided in PXE unless the benefits (such as stroke prevention in those who have had symptoms or previous stroke) outweigh the risks. If you have questions about specific symptoms, see your doctor for diagnosis and a treatment plan. [March 2006]

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2. Are GI bleeds more common or severe in PXE?


The overall incidence is unknown and it probably is not high. The presumption is when an individual with PXE has minor erosions, such as from aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) or from acid peptic disease bleed, the abnormal arterial vessels in PXE do not constrict normally to shunt blood away from the ulcerations. That is all conjecture. There is no published evidence that individuals with PXE have abnormal gastrointestinal linings or develop ulcerations more readily than the non-PXE population, but it hasn't been studied in any rigorous way.

Bleeding from ulcerations or superficial erosions is a problem, so aspirin and NSAIDs are best avoided. COX-2 inhibitors such as Celebrex and Bextra are probably safer than the COX-1 inhibitors such as Advil and Aleve, but they too are not totally without risk.  [March 2006]

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3 . Is intestinal angina related to PXE?


Intestinal angina is a known and described complication of PXE. This is a rare condition that, depending on the location and extent of arterial narrowing, may be treated with balloon angioplasty or surgery. Usually an angiogram is used to diagnose this condition and plan appropriate treatment, which is usually coordinated among gastroenterologist, surgeon, and interventional radiologist.  [March 2006]

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4. Does a colonoscopy have risks specific to PXE?


As far as PXE International is aware, there are no special risks of colonoscopy that are related to PXE - that is, the procedure should not be any riskier than in a person without PXE. There might be specific signs of PXE noted on colonoscopy, but these are not dangerous. You are encouraged to have this procedure if you are over 50, if you have risk factors for colon cancer, or if you have any medical issues, such as bleeding or anemia, that would warrant a colonoscopy. One recommendation: As with dental procedures, individuals who have mitral valve prolapse (floppy mitral valve) should consult a cardiologist or primary physician to learn whether they should take preventive antibiotics before the procedure. Let the gastroenterologist know if you have mitral-valve prolapse.  [March 2006]

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5. Is it safe for someone with PXE to take ibuprofen for inflammation?


Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of gastrointestinal bleeding, both because it can cause gastric stomach inflammation, and because it can inhibit the activity of platelets, which help to form blood clots when you are injured. This increases the risk of gastrointestinal bleeding In PXE. The risk is not high, but such hemorrhages can be severe. If an alternative therapy can be considered, that might be preferable.  [March 2006]

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6. Is it safe for someone with PXE to take Celebrex for inflammation?


Celebrex, is a COX-2 inhibitor, which means it has no platelet effects and appears less likely to cause GI bleeding than standard COX-1 inhibitor drugs, although it is not completely free of such risk. If a person with PXE needs a NSAID (nonsteroidal anti-inflammatory drug), Celebrex is probably the best choice, although it is not risk-free. Vioxx, a similar drug, has been withdrawn from the market because of an increased risk of cardiac complications such as heart attack. Therefore the potential cardiovascular risks of COX-2 inhibitors in PXE, a disease which is already associated with an increased risk of cardiovascular disease, must be taken into account by those prescribing these medications. [March 2006]

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7. Is there a safe anti-inflammatory?


There are treatments for rheumatoid arthritis, such as Enbrel and Remicade, that are injected or infused and do not cause GI bleeding, but they are very expensive and must be given under the supervision of an experienced rheumatologist. If you suspect arthritis, an internist or a rheumatologist (specialist in arthritis) should evaluate you so that a specific diagnosis as to the type of arthritis you have can be made, and the safest therapy for you can be prescribed.  [March 2006]

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8. Is it safe for someone with PXE to take Salsalate?


Disalcid (salsalate) is a non-steroidal anti-inflammatory drug (NSAID) that does not have an aspirin-like effect on platelets and is somewhat less irritating to the stomach than aspirin, so it is safer than aspirin for someone with PXE. However, as with Celebrex, the risk of GI bleeding is lower but not zero. Nothing is perfectly safe.  [March 2006]

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9. Is there a pain medication that will be safe for my stomach?


PXE International would not suggest narcotic medication as an alternative to a NSAID (nonsteroidal anti-inflammatory drug) as it is habit-forming. You should discuss this issue with your doctor, who should be aware of the risk of gastric bleeding in PXE and choose the drug with the lowest risk-benefit ratio.  [March 2006]

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Disclaimer


These are replies to general and specific questions which have been submitted to us in the past. Our responses may not apply to any particular individual´s situation and are not a substitute for medical advice given by a physician who is familiar with the individual´s case and who has examined the patient. In addition, the responses are updated on a periodic basis but may not be current.