Leong Rupert W L, Chan Francis K L
The University of New South Wales, Faculty of Medicine, Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Eldridge Road, Bankstown, NSW 2200, Sydney, Australia.
Expert Opin Drug Saf. 2006 Jul;5(4):585-92. doi: 10.1517/14740338.5.4.585.
With the ever-growing armamentarium of pharmacological agents, the gastrointestinal drug-induced side effects of dyspepsia, nausea, vomiting, diarrhoea and constipation are increasingly seen. They are often self-limiting and without serious sequelae, but of greater concern is drug-induced mucosal ulceration that can manifest as gastrointestinal haemorrhage, stricture and perforation. These complications are mainly attributable to NSAIDs and aspirin, which can injure the mucosa anywhere along the gastrointestinal tract. These iatrogenic serious side effects can be reduced with co-prescription of a proton pump inhibitor, substitution of a COX-2 inhibitor and eradication of Helicobacter pylori when the bacterium is present. Other recognised gastrointestinal complications include small intestinal diaphragm, microscopic colitis, a range of hepatotoxic effects and pancreatitis. The introduction of new classes of drugs has resulted in new adverse effects that require consideration in patients presenting with gastroenterological symptoms. These include pill oesophagitis from bisphosphonates and ischaemic colitis relating to serotonin antagonists. Here, the authors review the literature on drug-induced complications of the gastrointestinal tract and present the pertinent management issues relevant to clinical practice.
随着药物种类的不断增加，胃肠道药物引起的消化不良、恶心、呕吐、腹泻和便秘等副作用越来越常见。这些副作用通常是自限性的，不会产生严重后果，但更令人担忧的是药物引起的黏膜溃疡，可表现为胃肠道出血、狭窄和穿孔。这些并发症主要归因于非甾体抗炎药（NSAIDs）和阿司匹林，它们可损伤胃肠道任何部位的黏膜。通过联合使用质子泵抑制剂、改用COX-2抑制剂以及在存在幽门螺杆菌时将其根除，可减少这些医源性严重副作用。其他公认的胃肠道并发症包括小肠隔膜、显微镜下结肠炎、一系列肝毒性作用和胰腺炎。新型药物的引入导致了新的不良反应，在有胃肠症状的患者中需要加以考虑。这些不良反应包括双膦酸盐引起的药丸性食管炎以及与5-羟色胺拮抗剂相关的缺血性结肠炎。在此，作者回顾了关于药物引起的胃肠道并发症的文献，并提出了与临床实践相关的恰当管理问题。
