Lanas Angel
Service of Gastroenterology, University Hospital, Zaragoza, 50009, Spain.
Curr Treat Options Gastroenterol. 2006 Apr;9(2):147-56. doi: 10.1007/s11938-006-0033-4.
NSAIDs increase the risk of gastrointestinal (GI) complications. Those at risk should be considered for alternatives to NSAID therapy, modifications of risk factors, and prevention strategies with co-therapy with gastroprotective agents (proton-pump inhibitors or misoprostol) or COX-2 selective inhibitors (coxibs). Since coxibs, and probably other nonselective NSAIDs, may increase the risk of cardiovascular events, prevention strategies must take into account both GI and cardiovascular risk factors. All NSAIDs and coxibs should be prescribed at the lowest possible dose and for the shortest period of time. In patients with GI risk factors but no cardiovascular risk, coxibs or NSAIDs plus PPI or misoprostol are valid options. Patients with a history of ulcer bleeding should receive coxib plus PPI therapy and should be tested and treated for Helicobacter pylori infection. Most patients with increased cardiovascular risk will be treated with antiplatelet agents. It is not known whether co-therapy with low-dose aspirin will reduce the incidence of cardiovascular events, but it will further increase GI risk. It is currently unclear whether the risk of developing upper GI events with coxib plus aspirin is lower than it is with NSAIDs plus aspirin. However, all these patients should benefit from PPI co-therapy. Helicobacter pylori eradication should be considered as an additional therapeutic option when we want to further reduce the GI risk in specific patients. When the lower GI tract is of concern, coxib rather than NSAID therapy should be considered as the first option. Coxib therapy has better GI tolerance than NSAIDs, but patients with peptic ulcers or dyspepsia during NSAID/coxib treatment need PPI co-therapy.
非甾体抗炎药（NSAIDs）会增加胃肠道（GI）并发症的风险。对于有风险的患者，应考虑采用NSAID治疗的替代方案、改变风险因素以及采用与胃保护剂（质子泵抑制剂或米索前列醇）联合治疗或COX-2选择性抑制剂（昔布类）的预防策略。由于昔布类以及可能其他非选择性NSAIDs可能会增加心血管事件的风险，预防策略必须同时考虑胃肠道和心血管风险因素。所有NSAIDs和昔布类都应以尽可能低的剂量并在最短的时间内开具处方。对于有胃肠道风险因素但无心血管风险的患者，昔布类或NSAIDs加质子泵抑制剂或米索前列醇是有效的选择。有溃疡出血病史的患者应接受昔布类加质子泵抑制剂治疗，并应检测和治疗幽门螺杆菌感染。大多数心血管风险增加的患者将接受抗血小板药物治疗。低剂量阿司匹林联合治疗是否会降低心血管事件的发生率尚不清楚，但会进一步增加胃肠道风险。目前尚不清楚昔布类加阿司匹林发生上消化道事件的风险是否低于NSAIDs加阿司匹林。然而，所有这些患者都应从质子泵抑制剂联合治疗中获益。当我们希望进一步降低特定患者的胃肠道风险时，根除幽门螺杆菌应被视为一种额外的治疗选择。当关注下消化道时，应首先考虑昔布类而非NSAIDs治疗。昔布类治疗比NSAIDs具有更好的胃肠道耐受性，但在NSAIDs/昔布类治疗期间患有消化性溃疡或消化不良的患者需要质子泵抑制剂联合治疗。
