Treatment and Prevention of Gastroduodenal Complications of Non-ste-roidal Antiinflammatory Drugs

Overview

The aim of our study
is to give a survey of the most efficient methods for treatment and prevention of non-steroidalanti-inflammatory drug (NSAID)-induced gastrointestinal adverse in cases when antiphlogistic treatment cannot bediscontinued due to active and progressive joint disease. Analysis of published studies shows that, the proton pumpinhibitors (omeprazole) are the most efficient agents in treatment of gastric and duodenal ulcers induced by NSAIDs.The analysis shows a reliable effect of prostaglandin analogues (misoprostol) as well. Prostaglandin analogues(misoprostol) proved the most effective in treatment of gastric erosions.Prophylaxis of adverse gastrointestinal mucosal abnormalities can be primary or secondary. Secondary preventionis intended for patients with gastrointestinal symptoms or those treated for mucosal defects (ulcer, erosions). Thestandard prevention using H2 - antagonists or sucralphate does not provide sufficient protection against NSAID inthese patients, but omeprazole reduces the chance of a peptic lesion relapse.Primary prevention is intended for patients with a higher risk of gastrointestinal complications (age above 60,history of peptic ulcer, a higher dose of NSAID, simultaneous treatment with glucocorticoids or anticoagulants).Diclofenac with misoprostol and nabumetone reduce the incidence of gastroduodenal ulcers and their complicationsin short-term as well long-term studies. Meloxicam reduces the incidence of gastroduodenal mucosal abnormalitiesis short-term studies. Nimesulide is associated with a lower incidence of adverse gastrointestinal events, but the factis that, reliable data on gastroduodenal ulcer incidence reduction or their complications are not available.

Key words:
non-steroidal anti-inflammatory drugs, adverse effects, peptic ulcer, gastropathy, proton pumpinhibitor, omeprazole, misoprostol, nabumetone, meloxicam, nimesulide.