Watch out for NSAID hurting your stomach!
NSAID? Sounds a little strange. NSAID (pronounced as “ened”) is the acronym for this class of non-steroidal anti-inflammatory drugs. NSAIDs are useful, but there are serious concerns about damage to the gastrointestinal tract. Studies have shown that 8% to 16% of patients taking NSAIDs have gastrointestinal diseases associated with them; the incidence of patients with a previous history of gastric ulcers is as high as 33%, which shows the extent of NSAID damage to the gastrointestinal tract. symptoms of NSAID damage to the gastrointestinal tract include indigestion, stomach pain, bleeding, obstruction, perforation, and death. Gastroscopic manifestations are gastric mucosa congestion, edema, erosion, ulceration, bleeding, stenosis, and perforation. Li Jiqiang, Department of Gastroenterology, Shanghai Renji Hospital
There are many kinds of NSAIDs in common use. There are aspirin, diclofenac (diclofenac pain, futalin, kefiran), indomethacin (anti-inflammatory pain), ibuprofen (isobutylpropionic acid, isobutalofen, bupropion, fenbufen (biphenylbutazone acid), naproxen (metronidazole propionic acid, hypromellose), piroxicam (inflammatory pain xicam), meloxicam (mobicol), celecoxib (celecoxib), rofecoxib (vanillo), nimesulide ( Mysonin, Nimensol) Anacin, Aminopyrin, Pertussisone (Butazolidin, Butazone), etc.
How can NSAID damage the gastrointestinal tract so much? It can be briefly described as follows.
1, inhibition of gastric mucosal cell secretion of mucin and surface phospholipids, and destruction of the protective layer of gastric mucus.
2.Inhibit the secretion of bicarbonate by gastric epithelial cells, so that gastric acid can invade the inner layer of mucosa and damage the gastric mucosa.
3, inhibit the regeneration of gastric epithelial cells, weakening the repair ability of gastric mucosa.
4, inhibit the formation of new capillaries in the gastric mucosa, so that the blood flow to the gastric mucosa is reduced and the growth of granulation tissue is delayed.
NSAID is the combination of the above factors to destroy the gastric mucosal barrier and inhibit the gastric mucosal repair process, resulting in gastric mucosal erosion, ulceration and bleeding during the use of the drug.
However, NSAID does have good therapeutic effects such as antipyretic, analgesic, anti-inflammatory and anti-platelet aggregation, and is an essential clinical drug. Therefore ways to reduce or avoid these adverse effects must also be found.
It has been found that the reason why NSAID has such a powerful therapeutic effect is related to its ability to inhibit endogenous prostaglandin synthesis, and its damage to the gastrointestinal mucosa is precisely related to the inhibition of prostaglandin synthesis. Prostaglandins play an important role in maintaining the gastric mucosal barrier. It seems that the contradiction is difficult to resolve, and the therapeutic effects and side effects of NSAIDs are like twins inseparable.
However, scientists have found that NSAIDs inhibit prostaglandin synthesis by inhibiting an enzyme called cyclooxygenase, which has two isomeric enzymes —– cyclooxygenase-1 and cyclooxygenase-2. Cyclooxygenase-1 is found in the gastrointestinal wall, kidney, and platelets, while cyclooxygenase-2 is found in inflamed tissues. This is really called “the end of the mountain, there is no way, the darkness of the flowers and a village” ——– If we can find NSAIDs that only selectively inhibit cyclooxygenase-2 but not cyclooxygenase-1, can not play both anti-inflammatory and pain relief therapeutic effect without damaging the gastrointestinal mucosa?
So NSAIDs are divided into two categories: non-selective and selective. The ciclosporin (piroxicam, meloxicam) and celecoxib (celecoxib, rofecoxib) NSAIDs and nimesulide are the agents that are currently in use.
However, since selective NSAIDs are not yet popular and more expensive, non-selective NSAIDs are still widely used. What to do? Doctors have also conducted a lot of research.
The following measures can be taken to greatly reduce and mitigate the gastrointestinal side effects of a non-selective NSAID when it is used.
1. using the smallest effective dose of NSAID to minimize its damage to the gastrointestinal mucosa.
2, for patients who need to use larger doses of drugs, start with small doses so that the gastrointestinal mucosa adapts to the NSAID, which also helps to reduce gastrointestinal mucosal damage;
3.Avoid the use of two NSAIDs together.
4.Avoid the use of NSAID together with corticosteroids.
5.Use NSAID together with drugs that protect the gastrointestinal mucosa, such as misoprostol, famotidine, omeprazole, pantoprazole, esomeprazole, rabeprazole, lasorazole, bismuth potassium citrate, and aluminum thioglycollate.
6. Patients with a history of gastritis, gastroduodenal ulcer and elderly people over 60 years of age should be used with caution, closely observed and discontinued as soon as gastrointestinal symptoms appear.
7. Prohibit the use in patients with active peptic ulcer.
8. Selective NSAIDs such as meloxicam, rofecoxib, nimesulide, etc. should be used under possible conditions. However, attention should be paid to its side effects on the liver and kidneys, clinical application is still found to have mild gastrointestinal reactions, and it is still not suitable for patients with active peptic ulcer. By the way, selective NSAD may also become a drug to prevent colon cancer.
9. Once upper gastrointestinal bleeding occurs, the drug should be stopped immediately and treated as an emergency for upper gastrointestinal bleeding.
In summary, we must be fully alert to the side effects of NSAID damage to the gastric mucosa, and must take appropriate preventive measures while using such drugs, and pay close attention to the occurrence of any gastric bleeding.