[Prophylaxis and therapy of gastropathy caused by non-steroidal anti-inflammatory drugs].
BACKGROUND
The main disadvantage of the nonsteroidal anti-inflammatory drugs (NSAID) is their toxic effect on the gastroduodenal mucosa, which can cause life-threatening complications.


OBJECTIVE
We discuss the possibilities to prevent the harmful effect of the NSAIDs: the use of safer NSAIDs, and the co-therapy with protective mechanisms.


METHODS
Among the safer NSAIDs we discuss the preferentially selective, and the highly selective COX-2 inhibitors, and the new, nitric-oxide releasing NSAIDs. We consider the role of the mucosa-protecting mechanisms: antacids, sucralfate, H2 receptor antagonists, proton-pump inhibitors, and misoprostol.


CONCLUSIONS
The most effective opportunities to protect the gastroduodenal mucosa--which is highly recommended for the high risk group of patients--are the usage of highly selective NSAIDs, or the concomitant therapy with proton-pump inhibitors or misoprostol. The value of the letter is diminished by it's side effects.
Semmelweis Egyetem, Altalános Orvostudományi Kar, Kútvölgyi Klinikai Tömb, Budapest.
András
A
László
D000863:Antacids / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects; D005753:Gastric Mucosa / Q000187:drug effects* / Q000378:metabolism; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D010437:Peptic Ulcer / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control*; D011451:Prostaglandin-Endoperoxide Synthases; D011465:Prostaglandins, Synthetic / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D013392:Sucralfate / Q000627:therapeutic use
D000863:Antacids; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D006635:Histamine H2 Antagonists; D007527:Isoenzymes; D008565:Membrane Proteins; D011465:Prostaglandins, Synthetic; D054328:Proton Pump Inhibitors; D013392:Sucralfate; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases