Graham David Y
Department of Medicine, VA Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
Dig Dis Sci. 2002 Aug;47(8):1665-78. doi: 10.1023/a:1016495221567.
Bisphosphonates are widely prescribed to treat Paget's disease of the bone and to prevent and treat osteoporosis. Soon after the release of alendronate, esophagitis and esophageal strictures were encountered, resulting in labeling changes. Subsequent endoscopic studies in normal subjects showed that alendronate also caused gastric erosions and ulcers. Although the clinical significance of these is still uncertain, the anatomic distribution of both the gastric ulcers and esophageal damage is consistent with a topical irritant effect. Recent data also suggest a synergistic ulcerogenic potential of concurrent alendronate and NSAID use. A 70-mg once-weekly dosage form of alendronate has recently been approved and clinical experience with its gastrointestinal tolerability is ongoing. Risedronate, a third-generation bisphosphonate, appears to have less ulcerogenic potential than alendronate, and esophageal stricture has not been reported. Experience with the bisphosphonates provide a paradigm for the critical role of endoscopists in evaluating the gastrointestinal profile of new drugs. As bisphosphonates are more widely prescribed and more types of bisphosphonates are developed, the role of the gastroenterologist is likely to assume even more importance.
双膦酸盐类药物被广泛用于治疗骨Paget病以及预防和治疗骨质疏松症。阿仑膦酸钠上市后不久，就出现了食管炎和食管狭窄的情况，导致药品标签更改。随后对正常受试者进行的内镜研究表明，阿仑膦酸钠还会引起胃糜烂和溃疡。尽管这些情况的临床意义仍不确定，但胃溃疡和食管损伤的解剖分布与局部刺激作用一致。最近的数据还表明，同时使用阿仑膦酸钠和非甾体抗炎药具有协同致溃疡的可能性。阿仑膦酸钠70毫克每周一次的剂型最近已获批准，其胃肠道耐受性的临床经验仍在积累中。第三代双膦酸盐类药物利塞膦酸钠的致溃疡可能性似乎比阿仑膦酸钠小，且尚未有食管狭窄的报告。双膦酸盐类药物的使用经验为内镜医师在评估新药胃肠道情况方面的关键作用提供了一个范例。随着双膦酸盐类药物的处方越来越广泛，且开发出更多类型的双膦酸盐类药物，胃肠病学家的作用可能会变得更加重要。
