Prevention of nonsteroidal anti-inflammatory drug-induced gastropathy

被引：5

作者：

Barry Schlansky

Joo Ha Hwang

机构：

[1] University of Washington School of Medicine,

来源：

Journal of Gastroenterology | 2009年 / 44卷

关键词：

nonsteroidal anti-inflammatory drugs; peptic ulcer disease; gastropathy; gastric ulcer; duodenal ulcer;

D O I：

暂无

中图分类号：

学科分类号：

摘要：

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic, antipyretic, and antiinflammatory properties, and aspirin is increasingly employed in the primary and secondary prevention of cardiovascular disease and ischemic stroke. Despite undisputed therapeutic efficacy for these indications, all NSAIDs impart a considerable risk of peptic ulcer disease and upper gastrointestinal hemorrhage. A growing body of evidence supports an association between non-aspirin NSAIDs and acute coronary syndromes, and an expanding understanding of the gastroduodenal effects of aspirin, COX-2 selective agents, clopidogrel, and Helicobacter pylori synergism fuel controversies in NSAID use. In this review, we discuss risk stratification of patients taking NSAIDs and the appropriate application of proven gastro-protective strategies to decrease the incidence of gastrointestinal hemorrhage based upon an individualized assessment of risk for potential toxicities. Prevention of NSAID-related gastropathy is an important clinical issue, and therapeutic strategies for both the primary and secondary prevention of adverse events are continually evolving.

引用

页码：44 / 52

页数：8

共 308 条

[1]

Kaufman D.W.(2002)Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey JAMA 287 337-344

[2]

Kelly J.P.(2001)Approaches to nonsteroidal anti-inflammatory drug use in the high-risk patient Gastroenterology 120 594-606

[3]

Rosenberg L.(1999)Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs N Engl J Med 340 1888-1899

[4]

Anderson T.E.(2002)Arthropathy in art and the history of pain management: through the centuries to the cyclooxygenase-2 inhibitors Rheumatology 41 28-34

[5]

Mitchell A.A.(1971)Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs Nat New Biol 231 232-235

[6]

Laine L.(1999)Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis N Engl J Med 301 669-672

[7]

Wolfe M.M.(2000)Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor Am J Gastroenterol 95 1861-1890

[8]

Lichtenstein D.(1999)Anti-inflammatory and upper gastrointestinal effects of celecoxib in rheumatoid arthritis: a randomized controlled trial JAMA 282 1921-1928

[9]

Singh G.(1999)Celecoxib versus diclofenac in long-term management of rheumatoid arthritis: randomized double-blind comparison Lancet 354 2106-2111

[10]

Appelboom T.(2000)Gastrointestinal toxicity with celecoxib versus nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis. The CLASS study: a randomized controlled trial JAMA 284 1247-1255

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