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.

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Gastric ulceration induced by nonsteroidal anti-inflammatory drugs is a neutrophil-dependent process.

Also, this induced gastropathy goes on asymptomatically until it is too late and has caused further damage of the gastrointestinal tract. Selective COX-2 inhibitors, as the name suggests, are a group of drugs which selectively inhibit the COX-2 inhibitors, thus maintaining the anti-inflammatory properties of NSAIDs, yet retaining the gastroprotective action elicited gasyropati COX-1 pathway [ 83 — 85 ]. Other Synonyms of the Category: When refering to evidence in academic writing, you should always try to reference the primary original source.

View at Google Scholar Y. In contrast to this, some other trials did not find any enhanced risk of adverse effects of the use of PPI in combination with clopidogrel [ 7879 ].

NSAID-induced inhibition of COX also results in increased production of leukotrienes, one of the potent mediators of inflammation [ 49 — 51 ]. Further studies have demonstrated the role of recombinant human lactoferrin in decreasing acute NSAID-induced GI bleeding and reduction of gastric ulcers [].

PPIs are found to be effective in reducing the risk of GI bleeding in such patients [ 23 ]. COX-2 inhibitors are associated with fewer upper GI side effects, however, they are not as symptom free as hoped and still place people at risk of gastroduodenal mucosa injury. The microbial invasion and the damaged mucosa are considered as the main neutrophil chemoattractant.

Abstract Non-steroidal anti-inflammatory drugs are the most commonly prescribed drugs for arthritis, inflammation, and cardiovascular protection. The important role of bile acid an aggravating factor of NSAID-induced small intestinal injury was suggested by the result of an in vivo study that bile duct ligation reduced the prevalence of the lesions significantly.


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 ]. 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 ]. The pathophysiology of NSAID-induced small intestinal injuries was less well understood than that of gastric injuries.

Decreased blood flow and decreased mucosa decrease the healing ability and leave the stomach more exposed to injury from pepsin and gastric acid. In this regard, several prevention methods have been used. They were found to be effective against gastric ulceration to a considerable extent [ 61 ].

Crohn’s Disease is a type of inflammatory bowel disease which causes the gastrointestinal tract to be chronically inflammed.

Mediators of Inflammation

A potential complication of ulcers left untreated is that the ulcer can perforate through the stomach mucosa and cause infection to spread or the ulcer can erode stomach arteries creating a life-threatening bleed. Safe NSAID prescription should be straightforward since the most relevant aspects are clinical in nature. In these pathophysiological processes, the NSAID-induced inhibition of oxidative phosphorylation in mitochondria is considered as the main underlying mechanism.

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Free oxygen radicals react with poly unsaturated fatty acids of the mucosa leading to lipid peroxidation and tissue damage [ 54 ]. Mucous and bicarbonate are secreted by gastric epithelial cells.

The relative physiological importance of PGs in maintaining mucosal defense system between stomach and small intestine may contribute to the experimental and clinical results of NSAID-induced mucosal injuries.

Results of its efficacy compared to proton-pump inhibitors are awaited. View at Google Scholar D.

View at Google Scholar H. Gastric irritant-induced apoptosis in guinea pig gastric mucosal cells in primary culture. Nonsteroidal anti-inflammatory drugs NSAIDs are the most well recognized drugs worldwide for the treatment of pain, inflammation, and fever [ 1 — 4 ]. However, long-term administration of NSAIDs causes adverse gastrointestinal GI symptoms including mucosal lesions, bleeding, peptic ulcer, and inflammation in intestine leading to perforation, strictures in small and large intestines, leading to chronic problems [ 9 — 11 ].


Indomethacin-induced intestinal lesions in the rat. Prescription of PPIs is only recommended for patients on antiplatelet therapy who are at risk for gastrointestinal complications [ 25 ].

Ulcers of the small and large intestine. The principal physiological mechanisms which are compromised by NSAID use are mucosal blood flow, secretion of mucus and bicarbonate and maintenance of a hydrophobic mucosal surface. It is responsible for gastropqti synthesis of prostaglandins, which protects the stomach lining from the secreted acid, maintains gastroptai flow in gastric mucosa, and produces bicarbonate [ 3536 ].

Results for Non-steroidal anti-inflammatory drug-associated gastropathy disorder and additional synonyms. Patients taking aspirin represent a real challenge for treatment, since interaction with frequently prescribed NSAIDs gwstropati.

Similarly, nimesulide was highly selective against COX-2, so that at concentrations attained in vivo, while it had no substantial effect on COX-1, it suppressed COX-2 significantly [ 98 ].

Non-steroidal anti-inflammatory drug gastropathy: causes and treatment.

Our offer is non-binding. If you believe that this Physiopedia article is the primary source for the information you are refering to, you can use the button below to access a related citation statement. However, it fails to prevent the reduction of dyspepsia and other GI adverse effects and hence has a limited efficiency [ 5556 ].

View at Google Scholar M. This uncoulping causes dysfunction of the tight intracellular junctions and increases the intestinal gastdopati. NO formed by the action of nitric oxide synthase increases mucus and bicarbonate secretion as well as microcirculation and decreases neutrophil-endothelial adherence [ ].