title: Intestinal mucosal damage caused by non-steroidal anti-inflammatory drugs: role of bile salts.
abstract: The strong analgesic, anti-inflammatory effects of non-steroidal anti-inflammatory drugs (NSAIDs) are hampered by high occurrence of gastrointestinal side effects. Therapeutic actions of NSAIDs result from cyclooxygenase (COX) enzymes inhibition with reduced synthesis of prostaglandins, major modulators of inflammation. Since prostaglandins also regulate key events in gut homeostasis -mucosal secretion, blood flow, epithelial regeneration - COX inhibition has been accepted as the reason for NSAID gastrointestinal toxicity. Several findings challenge this theory: first, intestinal damage by NSAIDs occurs also in COX-1 knockout mice, demonstrating that topical (non-prostaglandin mediated) mechanisms are involved; second, no correlation is found in vivo between the extent of intestinal injury and the degree of inhibition of prostaglandin synthesis; third, bile flow interruption in animal models completely prevents intestinal damage by parenterally administered NSAIDs. What is in bile that could play a role in NSAID toxicity? This timely review will critically discuss the role of bile salts in NSAID-dependent gut damage.
authors.affiliation: Clinica Medica A. Murri, Department of Internal Medicine and Public Medicine (DIMIMP), University Medical School of Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Petruzzelli
authors.forename: Michele
authors.initials: M
authors.lastname: Vacca
authors.forename: Antonio
authors.initials: A
authors.lastname: Moschetta
authors.forename: Rosa
authors.initials: R
authors.lastname: Cinzia Sasso
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Palasciano
authors.forename: Karel J
authors.initials: KJ
authors.lastname: van Erpecum
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000494:pharmacology*; D001647:Bile Acids and Salts / Q000737:chemistry / Q000378:metabolism* / Q000502:physiology; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D008954:Models, Biological; D010743:Phospholipids / Q000737:chemistry / Q000378:metabolism; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001647:Bile Acids and Salts; D010743:Phospholipids; D011451:Prostaglandin-Endoperoxide Synthases