НПВП-ассоциированные повреждения желудочно-кишечного тракта и их осложнения: пути профилактики
НПВП-ассоциированные повреждения желудочно-кишечного тракта и их осложнения: пути профилактики
Пахомова И.Г. НПВП-ассоциированные повреждения желудочно-кишечного тракта и их осложнения: пути профилактики. Consilium Medicum. 2017; 19 (9): 109–113. DOI: 10.26442/2075-1753_19.9.109-113
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Pakhomova I.G. NSAID-associated lesions of the gastrointestinal tract and their complications: ways of preventing. Consilium Medicum. 2017; 19 (9): 109–113. DOI: 10.26442/2075-1753_19.9.109-113
НПВП-ассоциированные повреждения желудочно-кишечного тракта и их осложнения: пути профилактики
Пахомова И.Г. НПВП-ассоциированные повреждения желудочно-кишечного тракта и их осложнения: пути профилактики. Consilium Medicum. 2017; 19 (9): 109–113. DOI: 10.26442/2075-1753_19.9.109-113
________________________________________________
Pakhomova I.G. NSAID-associated lesions of the gastrointestinal tract and their complications: ways of preventing. Consilium Medicum. 2017; 19 (9): 109–113. DOI: 10.26442/2075-1753_19.9.109-113
Нестероидные противовоспалительные препараты (НПВП) достаточно широко используются в клинической практике большим кругом специалистов: от традиционной ревматологической и неврологической практики до врачей гинекологического профиля и многих других специалистов. Данный факт объясняется фармакологическими свойствами НПВП, которые являются эффективным инструментом в терапии боли и воспаления. Вместе с тем с учетом механизма действия данных лекарственных средств необходимо учитывать и класс-специфичные побочные эффекты применения НПВП, в первую очередь со стороны желудочно-кишечного тракта. Особого внимания заслуживают пациенты, нуждающиеся в длительном их применении и имеющие факторы риска развития НПВП-индуцированных гастротоксических поражений. Следовательно, важной задачей при назначении любого НПВП является правильный выбор в пользу эффективного и наиболее безопасного препарата с избирательным механизмом действия. Применение селективных ингибиторов циклооксигеназы-2 позволяет минимизировать частоту развития НПВП-индуцированных осложнений, в том числе и кровотечений. Популярным и широко применяемым в клинической практике лекарственным средством из данной группы препаратов является нимесулид, который имеет преимущества перед традиционными НПВП, эффективен и практически безопасен в купировании острой и хронической боли.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in clinical practice by a large number of specialists: from traditional rheumatological and neurological practices to gynecological doctors and many other specialists. This fact is explained by the pharmacological properties of NSAIDs, being an effective tool in the therapy of pain and inflammation. At the same time, taking into account the mechanism of action of these drugs, it is necessary to take into account class-specific side effects of NSAIDs, primarily on the part of the gastrointestinal tract. Particular attention should be paid to patients who need long-term use and have risk factors for the development of NSAID-induced gastro-toxic lesions. Therefore, an important task in the appointment of any NSAID is the right choice in favor of an effective and safest drug with a selective mechanism of action. The use of selective inhibitors of cyclooxygenase-2 allows to minimize the incidence of the development of NSAID-induced complications, including bleeding. A popular and widely used in the clinical practice drug from this group of drugs is nimesulide, which has advantages over traditional NSAIDs, is effective and practically safe in the management of acute and chronic pain.
Key words: nonsteroidal anti-inflammatory drugs, damage to the gastrointestinal tract, bleeding, prevention, nimesulide.
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1. Gel'fand B.R., Protsenko D.N., Babaiants A.V., Karateev A.E. Ostrye krovotecheniia iz verkhnikh otdelov zheludochno-kishechnogo trakta: ot epidemiologii do formirovaniia kontseptsii konservativnoi terapii. Infektsii v khirurgii. 2013; 4: 11–7. [in Russian]
2. Harirforoosh S, Asghar W, Jamali F. Adverse Effects of Nonsteroidal Antiinflammatory Drugs: An Update of Gastrointestinal, Cardiovascular and Renal Complications. J Pharm Pharm Sci (www.cspsCanada.org) 2013; 16 (5): 821–47.
3. Nasonov E.L., Karateev A.E. Porazheniia zheludka, sviazannye s priemom nesteroidnykh protivovospalitel'nykh preparatov. Klin. meditsina. 2000; 3, 4: 4–10. [in Russian]
4. Singh G, Lanes S, Triadafilopoulos G. Gastrointestinal complications of prescription and over-the-counter nonsteroidal anti-inflammatory drugs: a view from the ARAMIS database. Am J Med 2004; 117 (2): 100–6.
5. Lanas A, García-Rodríguez LA, Polo-Tomás M et al. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol 2009; 104: 1633–41.
6. Goldstein JL, Silverstein FE, Agrawal NM et al. Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor. Am J Gastroenterol 2000; 95: 1681–90.
7. Pincus Т, Swearingen C, Cummins P at al. Preference for nonsteroidal anti-inflammatory drugs versus acetaminophen and concomitant use of both types of drugs in patients with osteoarthri-tis. J Rheumatol 2000; 27: 1020–7.
8. Lanas A et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal antiinflammatory drug use. Am J Gastroenterol 2005; 100: 1685–93.
9. Hawkey CJ, Lanas AI. Doubt and certainty about non-steroidal anti-inflammatory drug in the year 2000: a multidisciplinary expert statement. Am J Med 2001; 8 (110): 79–100.
10. Garcia-Rodriguez LA. Risk of hospitalisation for upper gastrointestinal tract bleeding associated with Ketorolac, other NSAIDs, calcium antagonists, and other antihypertensive drugd. Arch Intern Med 1998; 158: 33–9.
11. Yeomans ND, Lanas AI, Talley NJ et al. Prevalence and incidence of gastroduodenal ulcers during treatment with vascular protective doses of aspirin. Aliment Pharmacol Ther 2005; 22: 795–801.
12. Meade TW. Oral anticoagulants in the secondary and primary prevention of myocardial infarction and coronary death. In: Oral Anticoagulants. Eds: Poller L, Hirsh J. Arnold. London: Hodder Headline Group, 1996: р. 132–42.
13. Karateev A.E., Nasonov E.L., Iakhno N.N. i dr. Klinicheskie rekomendatsii «Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike». Sovremen. revmatologiia. 2015; 1: 4–23. [in Russian]
14. Nasonov E.L. Effektivnost' i perenosimost' nesteroidnogo protivovospalitel'nogo preparata. Nimesulid: novye dannye. RMZh. 2001; 15: 6–8. [in Russian]
15. Rainsford K. Nimesulide – a multifactorial approach to inflammation and pain: scientific and. clinical consensus. Curr Med Res Opin 2006; 22 (6): 1161–79.
16. Conforti A, Leone R, Moretti U et al. Adverse drug reactions related to the use of NSAIDs with a focus on nimesulide: results of spontaneous reporting from a Northern Italian area. Drug Saf 2001; 24: 1081–90.
17. Yeomans ND, Tulassay Z, Juhasz L et al. A comparison of omeprazole with ranitidine for ulcers associatedwith non-steroidal anti-inflammatory drugs. N Engl J Med 1998; 338: 719–26.
18. Maev I.V., Kaziulin A.N. Ispol'zovanie rebamipida v kachestve tsitoprotektivnogo i protivovospalitel'nogo sredstva pri enteropatiiakh, indutsirovannykh nesteroidnymi protivovospalitel'nymi preparatami. Consilium Medicum. 2016; 18 (8): 8–12. [in Russian]
19. Malfertheiner P, Megraud F, O’Morain CA et al. Management of Helicobacter pylori infection – the Maastricht IV. Florence Consensus Report. Gut 2016; 0: 1–24.
20. Lehmann FS, Beglinger C. Impact of COX-2 inhibitors in common clinical practice a gastroenterologist's perspective. Curr Top Med Chem 2005; 5 (5): 449–64.
21. Davies NM, Saleh JY, Skjodt NM. Detection and prevention of NSAID-induced enteropathy. J Pharm Pharm Sci 2000; 3 (1): 137–55.
Авторы
И.Г.Пахомова
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41 pakhomova-inna@yandex.ru
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I.G.Pakhomova
I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41 pakhomova-inna@yandex.ru