Endoscopic and histopathological evaluation of acute gastric injury in high-dose acetaminophen and nonsteroidal anti-inflammatory drug ingestion with suicidal intent

Table 1 Maximum recommended daily dose according to drug type[6]

Drug	Dose (mg)
Acetaminophen	4000
Aspirin	4000
Etodolac	1200
Flurbiprofen	300
Ibuprofen	2400
Naproxen sodium	1375

Table 2 Endoscopic grading scale: LS[7,8]

Grade	Scale
0	No visible lesions
1	Redness and hyperemia in the mucosa
2	One or two erosions or hemorrhaging lesions
3	3-10 erosions or hemorrhaging lesions
4	> 10 erosions or hemorrhaging lesions or an ulcer

Note: Erosions are defined as flat, white-based mucosal breaks of any size; Ulcers are defined as mucosal breaks of at least 3 mm or more.

Table 3 Three-scaled histomorphologic scoring algorithm developed by us indicating the severity of the lesions according to microscopic findings of NSAID-related acute erosive/hemorrhagic gastritis

Score	Microscopic findings
1	Superficial epithelium is intact, edema at superficial lamina propria, dilated and congested capillary structures, extravasated erythrocyte and tiny fibrin clots
2	Multiple focal scattered erosions + 1
3	Disappearance of superficial epithelium, presence of proteinose materials on the surface of epithelium, diffuse hemorrhages within lamina propria, transmural ischemic necrosis + 2

Table 4 Comparison of LS and BS in relation to various patient characteristics

		LS (median)	BS (median)
Group	Patients	2.30 ± 1.18 (2)	2.26 ± 0.83 (2.5)
	Control group	0.77 ± 0.57 (1)	1.47 ± 0.73 (1)
	P	0.001	0.001
Age	r	0.391	-0.078
	P	0.005	0.592
History of gastric complaints	Positive	2.36 ± 1.43 (3)	2.09 ± 0.83 (2)
	Negative	2.28 ± 1.12 (2)	2.31 ± 0.83 (3)
	P	0.809	0.4
Smoking	Yes	2.08 ± 1.29 (2)	2.24 ± 0.88 (3)
	No	2.52 ± 1.04 (2)	2.28 ± 0.79 (2)
	P	0.234	0.949
Food intake	On full stomach	2.36 ± 1.17 (2)	2.27 ± 0.80 (2)
	On empty stomach	2.17 ± 1.24 (2)	2.23 ± 0.90 (3)
	P	0.576	0.964
H pylori	Positive	2.08 ± 1.19 (2)	2.32 ± 0.75 (2)
	Negative	2.52 ± 1.15 (2)	2 20 ± 0.91 (3)
	P	0.204	0.743
Duration of exposure	r	0.14	0.099
	P	0.332	0.492
Total drug dose (as multiples of maximum daily dose)	r	0.353	0.219
	P	0.012	0.127
Ingested drug	Acetaminophen only	1.89 ± 1.18 (2)	1.94 ± 0.87 (2)
	NSAID only	2.54 ± 1.21 (3)	2.58 ± 0.70 (3)
	P	0.086	0.013
Multiple NSAIDs	Yes	3.40 ± 0.70 (3.5)	2.50 ± 0.85 (3)
	No	2.02 ± 1.12 (2)	2.20 ± 0.82 (2)
	P	0.001	0.256

Analyses performed with Mann Whitney U test. r: Spearman’s rank correlation test.