It may occur when gastritis is accompanied by the over-expression of COX-2 protein and subsequent release of prostaglandins (PG), up-regulation of oxidative stress system and over-expression of cytokines such as IL-1 and TNF- associated with cytokine gene polymorphism
However, in this case, the patients usually do not show symptoms of metabolic acidosis or hemolytic anemia, and antioxidant therapies are ineffective (10)
Dependence and Withdrawal: Long-term use leads to severe dependence and withdrawal symptoms, such as fatigue, irritability, and cravings, which complicate cessation efforts
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