Correspondence should be addressed to Sujata Sharma; afrank2 gmail. Singh; tpsingh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Their analgesic, anti- inflammatory, and antipyretic actions may be beneficial; however, they are associated with severe side effects including gastrointestinal injury and peptic ulceration.
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Nonsteroidal anti-inflammatory drug NSAID treatment will be necessary as part of our therapeutic armamentarium for many years to come. Therefore, safe prescription is mandatory in order to prevent adverse events. In the last two decades, new strategies and new drugs have been developed to reduce NSAID-associated upper gastrointestinal GI adverse events.
Although the implementation of guidelines into clinical practice takes time, several studies have shown a recent and profound decrease in hospitalizations due to upper GI complications, which has been linked to widespread use of proton pump inhibitors PPIs , better NSAID prescription, and decreased prevalence of Helicobacter pylori infection.
This is encouraging. Safe NSAID prescription should be straightforward since the most relevant aspects are clinical in nature. Before issuing any prescription, three key questions should be considered:1 Is NSAID treatment necessary for this patient? For those at the highest risk, a combination of PPI plus a coxib is the best option. Also, eradication of H. Patients taking aspirin represent a real challenge for treatment, since interaction with frequently prescribed NSAIDs e.
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Abstract Nonsteroidal anti-inflammatory drug NSAID treatment will be necessary as part of our therapeutic armamentarium for many years to come. Lanas A. Curr Treat Options Gastroenterol. PMID: Turajane T, et al. J Med Assoc Thai. Strategies to optimize treatment with NSAIDs in patients at risk for gastrointestinal and cardiovascular adverse events.
Scheiman JM, et al. Clin Ther. PMID: Review. Evaluation of risk profiles for gastrointestinal and cardiovascular adverse effects in nonselective NSAID and COX-2 inhibitor users: a cohort study using pharmacy dispensing data in The Netherlands. Layton D, et al. Drug Saf. NSAID-induced gastrointestinal damage: current clinical management and recommendations for prevention.
Lanas A, Ferrandez A. Lanas A, et al. Chin J Dig Dis. Show more similar articles See all similar articles. Cited by 11 articles Current states of prevention of drug-induced gastroduodenal ulcer in real clinical practice: a cross-sectional study.
Iwamoto J, et al. J Clin Biochem Nutr. Epub Jan NSAIDs disrupt intestinal homeostasis by suppressing macroautophagy in intestinal epithelial cells. Chamoun-Emanuelli AM, et al. Sci Rep. Risk of post-stroke pneumonia with proton pump inhibitors, H2 receptor antagonists and mucoprotective agents: A retrospective nationwide cohort study. Song TJ, Kim J.
Song TJ, et al. PLoS One. Cherkas A, Zarkovic N. Cherkas A, et al. Antioxidants Basel. Evaluation of community pharmacists' roles in screening and communication of risks about non-steroidal anti-inflammatory drugs in Thailand. Phueanpinit P, et al. Prim Health Care Res Dev. Epub Mar Show more "Cited by" articles See all "Cited by" articles. References Arthritis Rheum. Full-text links [x] Springer. Copy Download.
Prevention and Treatment of NSAID Gastropathy
Their analgesic, anti-inflammatory, and antipyretic actions may be beneficial; however, they are associated with severe side effects including gastrointestinal injury and peptic ulceration. Though several approaches for limiting these side effects have been adopted, like the use of COX-2 specific drugs, comedication of acid suppressants like proton pump inhibitors and prostaglandin analogs, these alternatives have limitations in terms of efficacy and side effects. In this paper, the mechanism of action of NSAIDs and their critical gastrointestinal complications have been reviewed. This paper also provides the information on different preventive measures prescribed to minimize such adverse effects and analyses the new suggested strategies for development of novel drugs to maintain the anti-inflammatory functions of NSAIDs along with effective gastrointestinal protection.
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Current Perspectives in NSAID-Induced Gastropathy
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