Distribution of small intestinal mucosal injuries as a result of NSAID administration

Fujimori, Shunji; Gudis, Katya; Takahashi, Yōko; Seo, Tsuguhiko; Yamada, Yoshimi; Ehara, Akihito; Kobayashi, Tsuyoshi; Mitsui, Keigo; Yonezawa, Masaoki; Tanaka, Shu; Tatsuguchi, Atsushi; Sakamoto, Choitsu

doi:10.1111/j.1365-2362.2010.02290.x

Cited by 87 publications

(85 citation statements)

References 29 publications

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“…Fortunately, the animal models of NSAID enteropathy are very good, reproducible and simple, and can serve as useful tools for gaining a better understanding of the pathogenesis of this disorder and for testing potential therapeutic/preventative agents. Administration of NSAIDs to rats, for example, results in ulceration predominantly in the distal jejunum and ileum [52] , the same regions where ulcers are concentrated humans [53,54] . While there will undoubtedly be some differences between rodent models and humans, the existing data suggest that the animal models will be predictive in terms of treatment and prevention strategies.…”

Section: Pathogenesismentioning

confidence: 99%

“…On the other hand, this mechanism does not explain the localization of ulcers in the jejunum and ileum in animal models and in humans. In their endoscopic study of diclofenac-induced small intestinal injury, Fujimori et al [54] observed denuded regions throughout the small intestine (perhaps indicative of a topical erosive effect), but ulcers were concentrated in the distal jejunum and ileum.…”

Section: Mitochondrial Injurymentioning

confidence: 99%

“…Thus, when an NSAID recirculates enterohepatically, the intestinal epithelium is repeatedly exposed to a damaging combination of the NSAID and bile. If this were the primary mechanism of injury in NSAID-enteropathy, however, one would expect to see ulcers produced where the highest concentrations of NSAID and bile would be found (i.e., near the Sphincter of Oddi), whereas the most severe tissue injury is concentrated in the more distal parts of the small intestine [54] . It has been suggested that the sites of ulceration correspond to the sites of NSAID re-absorption, and related to the deconjugation of the NSAIDs at those sites by bacterial β-glucuronidases [79,[84][85][86] .…”

Section: Role Of Bile and Enterohepatic Circulationmentioning

confidence: 99%

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Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Wallace¹

2013

WJG

150

148

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This article reviews the latest developments in understanding the pathogenesis, detection and treatment of small intestinal damage and bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs). With improvements in the detection of NSAID-induced damage in the small intestine, it is now clear that this injury and the associated bleeding occurs more frequently than that occurring in the stomach and duodenum, and can also be regarded as more dangerous. However, there are no proven-effective therapies for NSAIDenteropathy, and detection remains a challenge, particularly because of the poor correlation between tissue injury and symptoms. Moreover, recent studies suggest that commonly used drugs for protecting the upper gastrointestinal tract (i.e. , proton pump inhibitors) can significantly worsen NSAID-induced damage in the small intestine. The pathogenesis of NSAIDenteropathy is complex, but studies in animal models are shedding light on the key factors that contribute to ulceration and bleeding, and are providing clues to the development of effective therapies and prevention strategies. Novel NSAIDs that do not cause small in- FRONTIER

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Section: Pathogenesismentioning

confidence: 99%

Section: Mitochondrial Injurymentioning

confidence: 99%

Section: Role Of Bile and Enterohepatic Circulationmentioning

confidence: 99%

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Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Wallace¹

2013

WJG

150

148

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“…Most of previous studies focused on pharmacoeconomic analysis regarding upper GI toxicities of NSAID uses. However, recent reports showed that a very high incidence of lower GI damage has been reported in young, healthy, human subjects taking both a non-selective NSAID and a PPI, indicating that the PPI conferred little protection to lower GI tracts, which are major sites of NSAID-induced bleeding and perforation [30][31][32]. And several studies showed that COX-2 selective inhibitor could be a better choice to reduce mucosal lesions of the small bowel compared with non-selective NSAID with PPI [33,34].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of Non-steroidal Anti-inflammatory Drugs Adjusting for Upper and Lower Gastrointestinal Toxicities in Rheumatoid Arthritis Patients

Chung

Park

2017

J Rheum Dis

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Objective. This study was performed to assess the cost-effectiveness of cyclooxygenase-2 (COX2)-selective inhibitor, non-selective non-steroidal anti-inflammatory drugs (NSAIDs), and non-selective NSAID with proton pump inhibitors (PPIs) while considering upper and lower gastrointestinal (GI) safety in patients with rheumatoid arthritis (RA). Methods. A Markov model was used to estimate the costs and effectiveness. Estimates of therapeutic efficacy and upper/lower GI safety were based on results from large randomized controlled trials. The main outcome measure was cost effectiveness, based on the quality-adjusted life years (QALYs) gained. Safety parameters included clinical upper GI symptoms, uncomplicated ulcer, upper GI bleeding, upper GI perforation, clinical lower GI symptoms, lower GI bleeding, and lower GI perforation. Cost data were obtained from patients treated in a tertiary referral center in Korea. Results. The expected three year cost was 3,052,800 Korean won (KRW) for COX2-selective inhibitor, 3,170,800 KRW for nonselective NSAID, and 3,325,900 KRW for non-selective NSAID with PPI. QALYs were 2.87446, 2.85320, and 2.85815, respectively. The total cost for COX2-selective inhibitor use was lower than non-selective NSAID, but QALY was higher, indicating that the incremental cost effectiveness ratio of COX2-selective inhibitor is superior. Conclusion. COX2-selective inhibitor has reasonable cost-effectiveness adjusted for upper and lower GI toxicity for patients with RA in Korea. (J Rheum Dis 2017;24:27-34)

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“…Videoendoszkópos vizsgálatok igazolták, hogy az NSAID-szedők 75%-ában alakul ki nyálkahártya-sérülés a distalis gastrointestinalis traktusban, amely a vékonybél proximalis szakaszán nyálkahártya-károsodással, az ettől distalisabb szakaszon többnyire fekélyképződéssel jellemezhető [121]. Ezek -szemben a felső szakaszon kialakult szövődményekkel -nem előzhetők meg protonpumpagátlók adásával, mivel a savas pH kialakulásukban nem játszik szerepet, sőt akár kedvezőtlen hatásúak is lehetnek dysbiosis kialakításával [122].…”

Section: Az Nsaid-ok Az Alsó Gastrointestinalis Traktusban Kialakuló unclassified

Nem szteroid gyulladáscsökkentők peroralis és transdermalis alkalmazása regionális mozgásszervi fájdalmi szindrómákban

et al. 2017

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A tanulmány szerzői a napi gyakorlatban a leggyakrabban fellépő mozgásszervi panaszok hátterében álló regionális fájdalmi szindrómák leggyakoribb kezelési módjával, a per os és transdermalisan alkalmazott nem szteroid gyulladás-csökkentőkkel végzett fájdalomcsillapításról rendelkezésre álló bizonyítékokat gyűjtötték össze. Azon szakterülete-ken működők számára, akik leggyakrabban találkoznak az átmeneti és fájdalmas epizódokkal (háziorvosok, reumatológusok, ortopédek, foglalkozás-egészségügyi és sportorvosok), külön meghatározták a foglalkozási vagy sporttevékenységük (a mozgásszervek ismétlődő vagy nagy energiájú igénybevétele) miatt kockázatnak kitettek körét és ismertetik fájdalmaik patológiai magyarázatát. A fájdalomcsillapítás eszközei között részletezik a nem szteroid gyulladáscsökkentők hatásának módját és farmakológiai sajátosságait. Kiemelik a gyógyszeres kezelés kockázatait és az emiatt veszélyeztettek speciális csoportjait (gyermekkorúak és idősek). Az általános fájdalomcsillapítási alapelvek és stratégiák ismertetésén túlmenően a hazai és nemzetközi irányelvekből a tanulmány tárgyára vonatkozó ajánlásokat adják közre. Orv Hetil. 2017; 158(Suppl. 3): 3-30.Kulcsszavak: nem szteroid gyulladáscsökkentők, regionális mozgásszervi fájdalmi szindrómák, mozgásszervi foglalkozási és sportbetegségek Peroral and transdermal application of non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of regional musculoskeletal pain syndromesIn this review the available evidences regarding the most frequently applied medication (peroral and transdermal non-steroidal anti-inflammatory agents) for the most frequent musculoskeletal complaints (regional pain syndromes) have been collected for the appropriate medical professionals who are most frequently faced with these conditions (general practitioners, rheumatologists, orthopedics, occupational and sports medicine experts). The special population at risk (with repeated and high energy overuse because of occupational or sport activities) and the pathology of their syndromes are identified. Mode of action, pharmacological properties of the non-steroidal anti-inflammatory drugs and the unwanted effects of their application especially in infants and elderly are highlighted. Recommendations of the general and specific pain management guidelines have been selected and listed in the review.

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Distribution of small intestinal mucosal injuries as a result of NSAID administration

Abstract: The impact of short-term NSAID medication on the small intestine differed according to intestinal site, with most denuded areas identified in the proximal part and all ulcers in the distal part.

Cited by 87 publications

References 29 publications

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Mechanisms, prevention and clinical implications of nonsteroidal anti-inflammatory drug-enteropathy

Cost-effectiveness of Non-steroidal Anti-inflammatory Drugs Adjusting for Upper and Lower Gastrointestinal Toxicities in Rheumatoid Arthritis Patients

Nem szteroid gyulladáscsökkentők peroralis és transdermalis alkalmazása regionális mozgásszervi fájdalmi szindrómákban

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