#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Gastroprotection in long-term use of non-steroidal antirheumatic drugs and low-dose acetylosalicylic acid


Authors: M. Bátovský
Authors‘ workplace: Gastroenterologická klinika FNsP a SZU
Published in: Gastroent Hepatol 2010; 64(3): 18-23
Category: Review Article

Overview

The incidence of non-steroidal anti-inflammatory drug /NSA/-related and low-dose acetylosalicylic acid /LD-ASA/-related ulcer complications remains high despite the availability of potent anti-ulcer drugs and selective cyclo-oxygenase-2 inhibitors. These complications can be minimized by a prospective assessment of the patient’s baseline risk, rational choice and use of NSA drugs and selective use of a co-therapy strategy with gastroprotectives. The presence of H. pylori infection significantly increases the risk of upper gastrointestinal complications in NSA drug users, suggesting that all patients requiring regular long-term NSA/LS-ASA drug therapy should be tested for H. pylori.

Key words:
gastroprotection – non-steroidal anti-inflammatory drugs – acetylosalicylic acid – Helicobacter pylori – proton pump inhibitors


Sources

1. Sung J, Russell RI, Nyeomans N et al. Non-steroidal anti-inflammatory drug toxicity in the upper gastrointestinal tract. J Gastroenterol Hepatol 2000; 15 (Suppl): G58–G68.

2. Nema H, Kato M, Katsurada T et al. Endoscopic survey of low-dose aspirin induced mucosal injuries in patients with ischemic heart disease. J Gastroenterol Hepatol 2008; 23 (Suppl 2): S234–S236.

3. Burette A, Marcelis Q, De Piez C et al. Epidemiological transition from H. pylori to NSAIDs/ASA in association with ulcer in Belgium: a 20 years prospective longitudinal study (1989-2008). Gut 2009; 58 (Suppl 2): A12.

4. Lazzaroni M, Bianchi-Porro G. Review article: Helicobacter pylori and NDSAID gastropathy. Aliment Pharmacol Ther 2001; 15 (Suppl 1): 22–27.

5. Martinek J, Hlavova K, Zavada F et al. „A surviving myth“ –corticosteroids are still considered ulcerogenic in a majority of physicians. Gut 2009; 58 (Suppl 2): A272.

6. Limmer S, Ittel TH, Wietholtz H. Secondary and primary prophylaxis of gastropathy associated with non-steroidal anti-inflammatory drugs or low-dose aspirin: a review based on four clinical scenarios. Z Gastroenterol 2003; 41(8): 719–728.

7. Richy F, Bruyere O, Ethgen O et al. Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis 2004; 63(7): 759–766.

8. Lukáš M, Kotlářová L. Inhibítory protónovej pumpy pri gastropatiách vyvolaných nesteroidnými antireumatikami. Medinews 2009; 3: 118–120.

9. Huang JQ, Sridhar S, Hunt RH. Role of Helicobacter pylori infection and non-steroidal-anti-inflammatory drugs in peptic ulcer disease: a meta-analysis. Lancet 2002; 359(9300): 14–22.

10. McDonald TM, Morant SV, Robinson GC et al. Association of upper-gastrointestinal toxicity of non-steroidal anti-inflammatory drugs with continued exposure: cohort study. Br Med J 1997; 315(7119): 1333–1337.

11. Chan FK, Graham DY. Review article: prevention of non-steroidal anti-inflammatory drug gastrointestinal complications – review and recommendations based on risk assessment. Aliment Pharmacol Ther 2004; 19(10): 1051–1061.

12. Laine L. Review article: gastrointestinal bleeding with low-dose aspirin – what’s the risk? Aliment Pharmacol Ther 2006; 24(6): 897–908.

13. Scheiman J, Rensburg CJ, Uebel P et al. Prevention of low-dose acetylsalicylic acid-associated gastric/duodenal ulcus with esomeprazole 20 mg and 40 mg once daily in patients at increased risk of ulcer development: a randomized controlled trial (OBERON). Gut 2009; 58 (Suppl 2): A273.

14. Scheiman JM. Strategies to reduce the GI risk of antiplatelet therapy. Rev Cardiovasc Med 2005; 6 (Suppl 4): S23–S31.

15. Juurlink DN, Gomes T, Ko DT et al. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ 2009; 180(7): 713–718.

16. O´Donoghue ML, Braunwald E, Antman EM et al. Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials. Lancet 2009; 374(9694): 989–997.

17. Hunt RH, Bazzoli F. Should NSAD/low-dose aspirin takers be tested routinely for H. pylori infection and treated if positive? Implications of primary risk of ulcer and ulcer relapse after initial healing. Aliment Pharmacol Ther 2004; Suppl 1: 9–16.

18. Shimada T, Yamagata M, Hiraishi H. Role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Nippon Rinsho 2007; 65(10): 1824–1829.

19. Chan FK. NSAID-induced peptic ulcers and Helicobacter pylori infections: implications for patient management. Drug Saf 2005; 28(4): 287–300.

20. Kiltz U, Zochling J, Schmidt WE et al. Use of NSAIDs and infection with Helicobacter pylori - what does the rheumatologists need to know? Rheumatology 2008; 47(9): 1265–1266.

21. Chan FK, Ching JI, Suen BY et al. H. pylori eradication alone on the long-term incidence of peptic ulcer bleeding in low-dose aspirin users with high gastrointestinal risk. Gut 2009; 58 (Suppl 2): A271.

22. Lanas A. Gastrointestinal injury from NSAID therapy. How to reduce the risk of complications. Postgrad Med 2005; 117(6): 23–28.

23. Graham DY. Helicobacter pylori and nonsteroidal anti-inflammatory drugs: interaction with proton pump inhibitor therapy for prevention of nonsteroidal anti-inflammatory drugs ulcers and ulcer complications – future research needs. Am J Med 2001; 110(1A): 58S–61S.

24. Layton D, Souverein PC, Heerdink ER et al. Evaluation of risk profiles for gastrointestinal and cardiovascular adverse effects in nonselective NSAID and COX-2 inhibitors users: a cohort study using pharmacy dispensing data in The Netherlands. Drug Saf 2008; 31(2): 143–158.

25. Brown TJ, Hooper L, Elliot RA et al. A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling. Health Technol Assess 2006; 38(10): 1–183.

26. Elliott RA, Hooper L, Payne K et al. Preventing non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: are older strategies more cost-effective in the general population? Rheumatology 2006; 45(5): 606–613.

27. Vonkeman HE, Braakman-Jansen LM, Klok RM et al. Incremental cost effectiveness of proton pump inhibitors for the prevention of non-steroidal anti-inflammatory drug ulcers: a pharmacoeconomic analysis linked to a case-control study. Arthritis Res Ther 2008; 10(6): R144.

28. Mason JM, Raghunath AS, Hungin AP et al. Helicobacter pylori eradication in long-term proton pump inhibitor users is highly cost effective: economic analysis of the HELPUP trial. Aliment Pharmacol Ther 2008; 28(11–12): 1297–1303.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#