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Ibuprofen and chronic pyloric stricture.

Ibuprofen and acetaminophen are the most widely used over-the-counter (OTC) pain relievers and antipyretics in the United States. Ibuprofen 2-(isobutylphenyl) propionic acid has been available without a prescription for those older than 12 years of age since 1984. Prescription for pediatric-strength liquid ibuprofen in children older than 6 months of age was approved by the Food and Drug Administration in 1989, and OTC administration for children older than 2 years of age since 1995. Its OTC use is now recommended by the American Academy of Pediatrics for children as young as 6 months of age. 
 
Chronic use of nonsteroidal anti-inflammaory drugs (NSAIDs) and aspirin increases the risk for gastrointestinal (GI) toxicity. The majority of peptic ulcers result from Helicobacter pylori infection and/or chronic NSAID use. An estimated 3% to 4.5% of adults taking regular NSAIDs for arthritis develop significant GI complications, with endoscopy revealing ulcers in 15% to 30%. (1) A single dose of aspirin may cause subepithelial hemorrhage, and a 1-week course of aspirin or NSAIDs is associated with ulcers in 8% of adults (1). 
 
In children, the frequency of GI bleed with ibuprofen, 17 in 100,000, is similar to that for acetaminophen (2). Although the gastric mucosa is most often affected, the intestinal mucosa may also be injured (3–5). 
 
Despite the increased use of NSAIDs in adults and children, current reports describe adverse events with high-dose short-term use, or with chronic exposure, primarily in adults. Reports of single exposures causing adverse events are few and represent the sequelae of massive 1-time ingestions (6). 
 
We report a previously healthy 2-year-old male who developed chronic gastric outlet obstruction and pyloric stricture after a single ingestion of liquid ibuprofen at a dose not thought to cause adverse events.