Laine Loren
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Semin Arthritis Rheum. 2002 Dec;32(3 Suppl 1):25-32. doi: 10.1053/sarh.2002.37217.
Nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin, are among the most frequently prescribed medications worldwide. The main factor limiting use of NSAIDs is concern about their gastrointestinal (GI) side effects. The purpose of this article is to review the incidence, pathophysiology, and risk factors of GI side effects associated with NSAID therapy. Upper GI symptoms, such as dyspepsia, occur in 15% to 60% of NSAID users, twice as often as in individuals not taking NSAIDs. The prevalence of gastric or duodenal ulcers in patients taking NSAIDs regularly is approximately 15% to 30%. The annual incidence of NSAID-related clinical upper GI events (complicated and symptomatic ulcers) is approximately 2.5% to 4.5%, with the annual incidence of serious complications (severe bleeding, perforation, and obstruction) about 1% to 1.5%. A history of ulcer or GI complications, advanced age, concomitant anticoagulation therapy or corticosteroid use, and high-dose or multiple NSAID therapy are associated with an increased risk of GI events during NSAID therapy. The cyclooxygenase (COX)-2 specific inhibitors (coxibs) have been developed in order to improve the GI safety and tolerability profile of therapy with NSAIDs. In numerous clinical trials, coxibs have been shown to have efficacy similar to that of nonselective NSAIDs, but are associated with significantly fewer endoscopic ulcers. In addition, 2 large outcome trials indicated that coxibs can also reduce the incidence of clinically important GI events.
非甾体抗炎药（NSAIDs），其中包括阿司匹林，是全球范围内处方量最高的药物之一。限制NSAIDs使用的主要因素是担心其胃肠道（GI）副作用。本文旨在综述与NSAID治疗相关的GI副作用的发生率、病理生理学及危险因素。上消化道症状，如消化不良，在15%至60%的NSAIDs使用者中出现，其发生率是非NSAIDs使用者的两倍。经常服用NSAIDs的患者中胃溃疡或十二指肠溃疡的患病率约为15%至30%。与NSAID相关的临床严重上消化道事件（复杂性和症状性溃疡）的年发生率约为2.5%至4.5%，严重并发症（严重出血、穿孔和梗阻）的年发生率约为1%至1.5%。溃疡或GI并发症病史、高龄、同时进行抗凝治疗或使用皮质类固醇以及高剂量或多种NSAIDs治疗与NSAID治疗期间GI事件风险增加相关。为了改善NSAIDs治疗的GI安全性和耐受性，已经开发出了环氧化酶（COX）-2特异性抑制剂（昔布类药物）。在众多临床试验中，昔布类药物已被证明具有与非选择性NSAIDs相似的疗效，但内镜下溃疡的发生率显著更低。此外，两项大型结果试验表明，昔布类药物还可降低临床上重要的GI事件的发生率。
