Non-steroidal anti-inflammatory drugs: how do they damage the gut?
NSAIDs are widely prescribed for the treatment of musculoskeletal disorders. The gastrointestinal tract, predominantly the stomach, bears the brunt of their side-effects. The basis of this toxicity is certainly multifactorial, with a wide range of local effects and mucosal defences being implicated. This review will highlight: (1) the epidemiology of NSAID-induced gastrointestinal toxicity; (2) their effects on prostaglandins, and the phenomenon of cytoprotection; (3) effects on neutrophil function; (4) effects on mucosal blood flow; (5) responses of the mucosa to damage (restitution, adaptation, and regenerative repair); (6) the relevance of growth factors; (7) interactions with Helicobacter pylori in ulcerogenesis, and finally (8) the effects of NSAIDs on the small intestine and colon.
Division of Gastroenterology, Royal Postgraduate Medical School, Hammersmith Hospital, London.
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Levi
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Shaw-Smith
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D004064:Digestive System / Q000187:drug effects* / Q000473:pathology; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D009140:Musculoskeletal Diseases / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal