What is an NSAID? Nonsteroidal Anti-inflammatory drug. In this paper, the mechanism of action of NSAIDs and their critical gastrointestinal complications have been reviewed. This paper also provides. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most highly prescribed drugs to decrease NSAID-induced GI damage including use of.

Author: Maule Grolkis
Country: China
Language: English (Spanish)
Genre: Medical
Published (Last): 6 October 2009
Pages: 43
PDF File Size: 9.24 Mb
ePub File Size: 11.34 Mb
ISBN: 800-1-21261-707-9
Downloads: 79943
Price: Free* [*Free Regsitration Required]
Uploader: Turan

Current Perspectives in NSAID-Induced Gastropathy

Recent reports also suggest that C-lobe of lactoferrin, which is resistant to enzymatic degradation [ ], has excellent sequestering property for such class of drugs [ ]. View at Google Scholar N. H2-receptor antagonists and proton pump inhibitors PPIs are most commonly used because they not only reduce acid secretion but also enhance gastric pH and have a role in scavenging-free radicals [ 5859 ]. The gastric defense mechanisms can be divided into three major components: That is usually the journal article where the information was first stated.

Their analgesic, anti-inflammatory, and antipyretic actions may be beneficial; however, they are associated with severe side effects including gastrointestinal injury and peptic ulceration.

Nonsteroidal anti-inflammatory drug gastropathy. Further studies have demonstrated the role of recombinant human lactoferrin in decreasing acute NSAID-induced GI bleeding and reduction of gastric ulcers []. However, recent experimental studies demonstrated that the PG deficient does not have a major role in the small intestine injuries.

Toggle navigation p Physiopedia. Other treatment options include misoprostol which is a synthetic prostaglandin designed to replace those loss by NSAIDs.

Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for arthritis, inflammation, and nxaid protection. Although the implementation of guidelines into clinical practice takes time, several studies have shown a recent and profound decrease in hospitalizations due to upper GI complications, which has been linked to widespread use of proton pump inhibitors PPIsbetter NSAID gastropatu, and decreased prevalence of Helicobacter pylori infection. Healing of NSAID ulcers by conventional doses of H2 antagonists is slow and H2 antagonists are poor at preventing gastric ulcer development or recurrence.


It seems that the framework of pathophysiology of NSAID-induced mucosal injury may differ in stomach and in small intestine. In human stomach, little or no COX-2 protein and activity was demonstrated, while abundant COX-1 protein and activity was demonstrated.

Any patient who presents with new onset of back or shoulder pain, who takes NSAIDs, and who presents with signs and symptoms of a peptic ulcer must be referred to the MD. Licofelone [2,2-dimethyl 4-chlorophenyphenyl-2,3-dihydro-1H-pyrrazolineyl]acetic acid has been identified as one of the most convincing compounds in this group [ ]. Di Matteo, and A. Our offer is non-binding. It is notable that the difference of aggravating factors between small intestine and stomach may explain the different biological responses and therefore the macroscopic lesions.

Mediators of Inflammation

In these pathophysiological processes, the NSAID-induced inhibition of oxidative phosphorylation in mitochondria is considered as the main underlying mechanism. However, acute studies of co-prescribed protective agents are highly predictive of performance in clinical practice. Subcategories, subconcepts or child concepts: Though several approaches for limiting these side effects have been adopted, like the use of COX-2 specific drugs, comedication of acid suppressants like proton pump inhibitors and prostaglandin analogs, these alternatives have limitations in terms of efficacy and side effects.

Reductions in prescribing arising from a prior authorization scheme show that this can be achieved. ROS from mitochondria play an important role in the release of cytochrome c and other pro-apoptotic proteins, which can trigger caspase activation and apoptosis. Before issuing any prescription, three key questions should be considered: Published online Feb Prescription of PPIs is only recommended for patients on antiplatelet therapy who are at risk for gastrointestinal complications [ 25 ].

Crohn’s Disease is a type of inflammatory bowel disease which causes the gastrointestinal tract to be chronically inflammed. However, these drugs suffer from serious drawbacks in cases of long-term administration, including severe GI complications. Thus, though routine use of a PPI is not recommended for patients in general, but it is coprescribed in patients with potential risk of GI bleeding [ 2580 ].


It significantly improved indomethacin-induced gastric ulceration and prevented NSAID-induced increase in leukotriene levels in gastric mucosa [ ]. Use of these drugs in certain types of cancer treatment has also been reported recently [ 67 ]. These medications are discussed below in the medical management section. Preliminary trial of rebamipide gastroptai prevention of low-dose aspirin-induced gastric injury in healthy subjects: It has nzaid reported that concurrent use of clopidogrel plus a PPI was associated with a significant increase in risk of an adverse cardiovascular event in patients with acute chronic syndrome [ 7677 ].

Prevention and Treatment of NSAID Gastropathy.

However, some reports have suggested that PPIs interfere with clopidogrel to impair platelet function [ 232475 ]. The main drawback of PPIs is that they are less effective against mucosal injury in more distal parts of the intestine like NSAID-induced colonopathy [ 81 ]. Gasttopati, lipid peroxidation, and apoptosis A mitochondrion is a membrane-enclosed organelle with 0. Derivatives of naproxen, diclofenac, and indomethacin which can release H2S have been reported [ — ]. For high-risk patients requiring continuing NSAID use co-prescription of omeprazole or misoprostol should be considered.

View at Google Scholar Y. In gastric juice, they are non-ionized and lipid soluble.

Blood flow provides an adequate supply of micronutrients and oxygen gastropai order for epithelial cells to secrete mucous and bicarbonate. Therefore, it is essential that health care professionals assess each patient’s risk factors and recommend either discontinued use of an NSAID or inclusion an accompanying cytoprotectant agent in those patients considered high risk.