Peura David A, Goldkind Lawrence
University of Virginia Health System, Charlottesville, Virginia, USA.
Arthritis Res Ther. 2005;7 Suppl 4(Suppl 4):S7-13. doi: 10.1186/ar1793. Epub 2005 Sep 15.
Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of medications to treat pain and inflammation. However, gastrointestinal complications associated with NSAIDs are prevalent, largely due to the frequent use of these agents. Adverse events associated with NSAIDs include minor side effects, such as dyspepsia, as well as serious complications, such as bleeding and perforation. Although the probability that any given individual user of an NSAID will suffer a serious gastrointestinal complication is fairly low, widespread patient exposure can translate into a major national health burden. The increasing use of aspirin in the prevention of cardiovascular events and the availability of select over-the-counter NSAIDs represent additional challenges to clinicians in their efforts to make the most appropriate therapeutic decisions while minimizing the potential gastrointestinal risks associated with the use of these agents. Side effects such as dyspepsia do not provide adequate warning of gastrointestinal complications, because most complications occur without the presence of antecedent symptoms. Therefore, accurate risk assessment and the management of controllable risk factors are crucial to the safe administration of NSAIDs. This review focuses on the gastrointestinal effects of aspirin, acetaminophen, and other nonselective NSAIDs, and discusses those factors that are associated with increased risk for adverse gastrointestinal events in certain individuals.
非选择性非甾体抗炎药（NSAIDs）是治疗疼痛和炎症最常用的药物类别之一。然而，与NSAIDs相关的胃肠道并发症很普遍，这在很大程度上归因于这些药物的频繁使用。与NSAIDs相关的不良事件包括消化不良等轻微副作用，以及出血和穿孔等严重并发症。尽管任何特定NSAIDs个体使用者发生严重胃肠道并发症的概率相当低，但广泛的患者接触可能转化为重大的国家健康负担。阿司匹林在预防心血管事件中的使用增加以及某些非处方NSAIDs的可得性，对临床医生在做出最恰当治疗决策同时尽量降低使用这些药物潜在胃肠道风险的努力构成了额外挑战。消化不良等副作用并不能充分警示胃肠道并发症，因为大多数并发症在没有前期症状的情况下就会发生。因此，准确的风险评估和可控风险因素的管理对于NSAIDs的安全给药至关重要。本综述重点关注阿司匹林、对乙酰氨基酚和其他非选择性NSAIDs的胃肠道影响，并讨论与某些个体不良胃肠道事件风险增加相关的因素。
