Lehmann F S, Beglinger C
Abteilung für Gastroenterologie, Universitätsspital Basel.
Schweiz Med Wochenschr. 1999 Jul 27;129(29-30):1073-80.
The administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is frequently associated with injury to the gastroduodenal mucosa and leads in approximately 1.5% of patients to severe complications such as haemorrhage or perforation. The risk of serious upper GI complications is increased in patients > 65 years with a previous history of peptic ulcer disease or gastrointestinal haemorrhage, concomitant steroid use and significant cardiovascular comorbidity. Previous studies have shown that misoprostol is effective in reducing the incidence of gastric and duodenal ulcers as well as serious gastrointestinal complications. Recently, four large clinical trials have demonstrated that omeprazole is effective in preventing and treating NSAID-induced ulcers. Omeprazole when compared to misoprostol was equally effective in preventing gastric ulcers and more effective in duodenal ulcers. For treatment of gastric and duodenal ulcers, omeprazole was more effective than misoprostol and ranitidin. Prophylaxis of NSAID-induced ulcers should be administered in all patients with several risk factors for serious gastrointestinal complications.
非甾体抗炎药（NSAIDs）的使用常常与胃十二指肠黏膜损伤相关，约1.5%的患者会出现严重并发症，如出血或穿孔。65岁以上、有消化性溃疡病史或胃肠道出血史、同时使用类固醇以及有严重心血管合并症的患者发生严重上消化道并发症的风险会增加。既往研究表明，米索前列醇可有效降低胃和十二指肠溃疡的发生率以及严重胃肠道并发症的发生率。最近，四项大型临床试验表明，奥美拉唑可有效预防和治疗NSAIDs引起的溃疡。与米索前列醇相比，奥美拉唑在预防胃溃疡方面同样有效，在预防十二指肠溃疡方面更有效。在治疗胃和十二指肠溃疡方面，奥美拉唑比米索前列醇和雷尼替丁更有效。对于所有有严重胃肠道并发症多种危险因素的患者，均应进行NSAIDs引起溃疡的预防。
