Non-steroidal anti-inflammatory drugs and gastrointestinal damage—problems and solutions

Areas of the gastrointestinal tract that may be damaged by NSAIDs Oesophagus: oesophagitis, ulceration, stricture Stomach: ulcers, erosions Duodenum: ulcers, erosions Small intestine: ulcers, erosions, protein loss, strictures Colon: non-specific colitis, exacerbation of ulcerative colitis and Crohn...

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Bibliographic Details
Published in:Postgraduate Medical Journal 2001-02, Vol.77 (904), p.82-88
Main Author: Russell, R I
Format: Article
Language:English
Subjects:
Adaptation
Aged
Anti-Inflammatory Agents, Non-Steroidal - administration & dosage
Anti-Inflammatory Agents, Non-Steroidal - adverse effects
Anti-Ulcer Agents - therapeutic use
Aspirin
Aspirin - administration & dosage
Aspirin - adverse effects
Biological and medical sciences
Complications and side effects
Crohns disease
Cyclooxygenase Inhibitors - administration & dosage
Cyclooxygenase Inhibitors - adverse effects
Drug dosages
Drug toxicity and drugs side effects treatment
Endoscopy
Gastroenterology. Liver. Pancreas. Abdomen
gastrointestinal damage
Gastrointestinal Diseases - chemically induced
Gastrointestinal Diseases - prevention & control
Gastrointestinal Hemorrhage - chemically induced
Gastrointestinal mucosa
Helicobacter Infections - complications
Helicobacter pylori
Humans
Inflammatory bowel disease
Injuries
Medical sciences
non-steroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs
Other diseases. Semiology
Patients
Pharmacology. Drug treatments
Physiology
Review
Rheumatoid arthritis
Risk Factors
Side effects
Small intestine
Stomach Ulcer - chemically induced
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Studies
Substance abuse treatment
Toxicity: digestive system
Wound Healing - drug effects
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Summary:Areas of the gastrointestinal tract that may be damaged by NSAIDs Oesophagus: oesophagitis, ulceration, stricture Stomach: ulcers, erosions Duodenum: ulcers, erosions Small intestine: ulcers, erosions, protein loss, strictures Colon: non-specific colitis, exacerbation of ulcerative colitis and Crohn's disease A recent necropsy study of 713 patients has been reported, of whom 244 had NSAIDs prescribed during the six months before death and 464 had not; death in all patients was unrelated to NSAID use. COX-1 and COX-2 COX-1 Constitutively expressed in most tissues: stomach, duodenum, kidneys, platelets Key role in the production of prostaglandins which regulate physiological processes: gastrointestinal protection, blood flow, adaptation, cellular recovery, maintenance of good renal function, vascular homoeostasis important "housekeeping" role COX-2 Normally undetectable in most tissues Can be induced rapidly and in large quantities in the presence of inflammation and other pathological processes Most conventional NSAIDs are non-selective in their COX inhibition, exerting their anti-inflammatory effects through the inhibition of COX-2, but having adverse effects (such as gastrointestinal mucosal damage and nephrotoxicity) primarily due to inhibition of COX-1.
ISSN:0032-5473
1469-0756
DOI:10.1136/pmj.77.904.82