Current Topics of Strategy of NSAID-Induced Small Intestinal Lesions.
Small intestinal mucosal injuries have been recently recognized as common complications associated with non-steroidal anti-inflammatory drugs (NSAIDs) because video capsule endoscopy and balloon enteroscopy are now available for the detection of small intestinal lesions. Small intestinal injury occurs not in an acid-dependent mechanism but by various factors such as enteric bacteria, bile acids, prostaglandin (PG) deficiency and topical factors (abnormal intestinal mucosal permeability, mitochondrial dysfunction, reactive oxygen species, endoplasmic reticulum stress and so on), and there is no well-established prophylactic approach. Several experimental and clinical studies found the effectiveness of some of the mucoprotective drugs, PG analogs, but not that of acid suppressants. Considering the effect of proton pump inhibitors (PPIs) for upper gastrointestinal (GI) disease and in the small intestine, the following 2 kinds of strategies against NSAID-induced GI injuries may be recommended. In patients with a high risk of upper GI disease (peptic ulcer etc.), simultaneous administration of a PPI (for upper GI disease) and a mucoprotective drug (for small intestine) is needed to prevent NSAID-induced GI injury. In other cases, an effective mucoprotective drug is enough for the protection of the entire digestive tract, that is, starting from the esophagus to the small intestine. These strategies may fulfill both economical and curative effects.
2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan.
Shoko
S
Edogawa
Toshihisa
T
Takeuchi
Yuichi
Y
Kojima
Kazuhiro
K
Ota
Satoshi
S
Harada
Takanori
T
Kuramoto
Ken
K
Narabayashi
Takuya
T
Inoue
Kazuhide
K
Higuchi
D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D053704:Capsule Endoscopy; D004195:Disease Models, Animal; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects*; D007421:Intestine, Small / Q000187:drug effects*; D011453:Prostaglandins / Q000378:metabolism; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D051381:Rats
D000894:Anti-Inflammatory Agents, Non-Steroidal; D011453:Prostaglandins; D054328:Proton Pump Inhibitors