COMBINED NSAID-INDUCED LESIONS OF THE GASTROINTESTINAL TRACT: FREQUENCY, CLINICAL AND ENDOSCOPIC FEATURES, TREATMENT
https://doi.org/10.21886/2712-8156-2020-1-1-64-69
Abstract
Purpose: to study the frequency of lesions of the gastrointestinal tract in NSAIDs users with rheumatoid diseases, as well as to increase the effectiveness of therapeutic and preventivestrategies.
Matherials and methods: 112 patients (50 men, 62 women) with various rheumatic diseases and long-term NSAIDs were examined. All patients underwent upper and lower endoscopy, in some patients video capsule endoscopy of the small intestine was also performed.
Results: аccording to the data obtained, the most common NSAID-induced gastrointestinal damage was NSAID-gastropathy, observed in 43 % of all NSAID users. 68.6 % of patients with NSAID gastropathy during video capsule endoscopy were additionally diagnosed with NSAID enteropathy, and 9 % of patients with NSAID gastropathy were also diagnosed with NSAID colopathy, which were significantly more common in patients receiving non-selective NSAIDs. Combined lesions of all sections of the gastrointestinal tract, the gastroduodenal zone, small and large intestine, were observed in a significant number of patients — in 27 % of cases, most often in patients with rheumatic diseases who took non-selective NSAIDs. A generalization of the existing experience in the treatment of patients with NSAID-induced gastrointestinal lesions showed that in the case of a combination of NSAID-gastropathy and NSAID-enteropathy, the preferred preventive strategies should be H. pylori eradication, the use of rebamipide and the use of selective COX-2 inhibitors. With the combination of NSAIDs with concomitant excess bacterial growth syndrome and NSAIDs-colopathy, rifaximin, rebamipid and sulfalazine are effective.
Conclusions: the data obtained confirm the high prevalence of combined lesions of the proximal and distal gastrointestinal tract in rheumatological patients, which may indicate a universal damaging effect of NSAIDs on the entire gastrointestinal tract.
About the Authors
A. P. Balabantseva
S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Cand. Sci. (Med.)
Simferopol
I. L. Klyaryts`kaya
S.I. Georgievsky Medical Academy, V.I. Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Dr.Sci. (Med.), Prof.,
Simferopol
A. I. Ostapenko
N.A. Semashko Republican Clinical Hospital
Russian Federation
Russian Federation
Dr.Sci. (Med.)
Simferopol
References
1. Conaghan, PG. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatology International. 2011;32(6):1491–1502. DOI:10.1007/s00296-011-2263-6
2. Dubois RW, Melmed GY, Henning JM, Laine, L. Guidelines for the appropriate use of non-steroidal anti-inflammatory drugs, cyclo-oxygenase-2-specific inhibitors and proton pump inhibitors in patients requiring chronic antiinflammatory therapy. Alimentary Pharmacology and Therapeutics. 2004;19(2):197–208. DOI: 10.1111/j.0269-2813.2004.01834.x
3. Vaduganathan M, Bhatt DL, Cryer BL, Liu Y, Hsieh W-H, Doros G., et al. Proton-Pump Inhibitors Reduce Gastrointestinal Events Regardless of Aspirin Dose in Patients Requiring Dual Antiplatelet Therapy. Journal of the American College of Cardiology. 2016;67(14):1661–1671. DOI: 10.1016/j.jacc.2015.12.068
4. Koffeman AR, Valkhoff VE, Çelik S, Jong GW. ’t, Sturkenboom MC, et al. High-risk use of over-the-counter non-steroidal antiinflammatory drugs: a population-based cross-sectional study. British Journal of General Practice. 2014;64(621):e191–e198. DOI: 10.3399/bjgp14x677815
5. Lanas A, Boers M, Nuevo J. Gastrointestinal events in atrisk patients starting non-steroidal anti-inflammatory drugs (NSAIDs) for rheumatic diseases: the EVIDENCE study of European routine practice. Annals of the Rheumatic Diseases. 2013;74(4):675–681. DOI: 10.1136/annrheumdis-2013-204155
6. Lanas A, Sopeña F. Nonsteroidal Anti-Inflammatory Drugs and Lower Gastrointestinal Complications. Gastroenterology Clinics of North America. 2009;38(2):333–352. DOI: 10.1016/j.gtc.2009.03.007
7. Marcelo P, Lazdin CF, Drug - induced bleeding gastroenteropathy. EC Gastroenterology and Digestive System. 2017;2:459-462.
8. Adebayo D. Is non-steroidal anti-inflammaory drug (NSAID) enteropathy clinically more important than NSAID gastropathy? Postgraduate Medical Journal. 2006;82(965):186–191. DOI: 10.1136/pgmj.2005.039586
9. Chan FKL. NSAID-Induced Peptic Ulcers and Helicobacter pylori Infection. Drug Safety. 2005;28(4):287–300. DOI: 10.2165/00002018-200528040-00002
10. Chan FKL, Graham DY. Prevention of non-steroidal antiinflammatory drug gastrointestinal complications - review and recommendations based on risk assessment. Alimentary Pharmacology and Therapeutics. 2004;19(10):1051–1061. DOI:10.1111/j.1365-2036.2004.01935.x
11. Smale S, Tibble J, Sigthorsson, G, Bjarnason, I. Epidemiology and differential diagnosis of NSAID-induced injury to the mucosa of the small intestine. Best Practice & Research Clinical Gastroenterology. 2001;15(5), 723–738. DOI: 10.1053/bega.2001.0231
12. Sugimori S, Watanabe T, Tabuchi M, Kameda N, Machida H, Okazaki H., et al. Evaluation of Small Bowel Injury in Patients with Rheumatoid Arthritis by Capsule Endoscopy: Effects of Anti-Rheumatoid Arthritis Drugs. Digestion. 2008;78(4):208–213. DOI: 10.1159/000190403
13. Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FKL, et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use. The American Journal of Gastroenterology. 2008;103(11):2890–2907. DOI:10.1111/j.1572-0241.2008.02216.x
14. Lanza FL, Chan FKL, Quigley EMM. Guidelines for Prevention of NSAID-Related Ulcer Complications. American Journal of Gastroenterology. 2009;104(3):728–738. DOI:10.14309/00000434-200903000-00035
15. Suyata S, Bustami E, Bardiman S, Bakry F. A Comparison of Efficacy between Rebamipide and Omeprazole in the Treatment of NSAIDs Gastropathy. IndonesianJ. Gastroenterol. Hepatol. Dig. Endoscopy. 2004;5.89–94. https://doi.org/10.24871/53200489-94
16. Fujimori S, Gudis K, Takahashi Y, Seo T, Yamada Y, Ehara A. et al. Distribution of small intestinal mucosal injuries as a result of NSAID administration. European Journal of Clinical Investigation. 2010;40(6):504–510. DOI:10.1111/j.1365-2362.2010.02290.x
17. Compare D, Pica L, Rocco A, De Giorgi F, Cuomo R, Sarnelli G, et al. Effects of long-term PPI treatment on producing bowel symptoms and SIBO. European Journal of Clinical Investigation. 2010;41(4):380–386. DOI:10.1111/j.1365-2362.2010.02419.x
18. Fortun PJ, Hawkey CJ. Nonsteroidal antiinflammatory drugs and the small intestine. Current Opinion in Gastroenterology. 2007;23:134-141. DOI:10.1097/mog.0b013e328020045a
Review
For citations:
Balabantseva A.P., Klyaryts`kaya I.L., Ostapenko A.I. COMBINED NSAID-INDUCED LESIONS OF THE GASTROINTESTINAL TRACT: FREQUENCY, CLINICAL AND ENDOSCOPIC FEATURES, TREATMENT. South Russian Journal of Therapeutic Practice. 2020;1(1):64-69. (In Russ.) https://doi.org/10.21886/2712-8156-2020-1-1-64-69
Views:
1017
Email this article 