Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.
Nonsteroidal anti-inflammatory drugs and upper and lower gastrointestinal mucosal damage.
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DOI：
10.1186/ar4175
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发表时间：
2013
影响因子：
4.9
通讯作者：
Lanas A
中科院分区：
文献类型：
--
作者：
Sostres C;Gargallo CJ;Lanas A
NSAID是世界上最常用的药物之一，其有益的治疗特性被完全接受。然而，它们也与胃肠道（GI）不良事件相关。NSAID可损害整个胃肠道，包括广泛的病变。大约1 - 2%的NSAID使用者在治疗期间经历了严重的胃肠道并发症。NSAID使用者中上消化道并发症的相对风险取决于不同风险因素的存在，除了NSAID的类型和剂量外，还包括年龄较大（>65岁）、复杂性消化性溃疡病史和伴随使用阿司匹林或抗凝剂。一些作者最近报告了上消化道并发症导致的住院率呈下降趋势，而下消化道并发症导致的住院率显著增加，导致这两种类型的胃肠道并发症的发生率趋于一致。非甾体类抗炎药引起的肠病在过去几年中得到了广泛的关注，越来越多的报告已经发表在这个问题上。目前的证据表明，非甾体抗炎药增加下消化道出血和穿孔的风险，其程度与上消化道相似。选择性环氧合酶-2抑制剂与非选择性NSAID具有相同的有益作用，但在上消化道和下消化道中的胃肠道毒性较小。总体而言，这些并发症导致的死亡率也有所下降，但尽管采取了新的治疗和预防策略，但上消化道和下消化道并发症事件的院内病死率仍保持不变。
NSAIDs are among the most commonly used drugs worldwide and their beneficial therapeutic properties are thoroughly accepted. However, they are also associated with gastrointestinal (GI) adverse events. NSAIDs can damage the whole GI tract including a wide spectrum of lesions. About 1 to 2% of NSAID users experienced a serious GI complication during treatment. The relative risk of upper GI complications among NSAID users depends on the presence of different risk factors, including older age (>65 years), history of complicated peptic ulcer, and concomitant aspirin or anticoagulant use, in addition to the type and dose of NSAID. Some authors recently reported a decreasing trend in hospitalizations due to upper GI complications and a significant increase in those from the lower GI tract, causing the rates of these two types of GI complications to converge. NSAID-induced enteropathy has gained much attention in the last few years and an increasing number of reports have been published on this issue. Current evidence suggests that NSAIDs increase the risk of lower GI bleeding and perforation to a similar extent as that seen in the upper GI tract. Selective cyclooxygenase-2 inhibitors have the same beneficial effects as nonselective NSAIDs but with less GI toxicity in the upper GI tract and probably in the lower GI tract. Overall, mortality due to these complications has also decreased, but the in-hospital case fatality for upper and lower GI complication events has remained constant despite the new therapeutic and prevention strategies.
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影响因子：
5.4
作者：
Gutthann, SP;Rodriguez, LAG;Raiford, DS
通讯作者：
Raiford, DS
影响因子：
29.4
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Marano, P
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影响因子：
168.9
作者：
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通讯作者：
Sung, JJY
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29.4
作者：
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通讯作者：
MENZIES, IS