Hirschowitz B I, Lanas A
Division of Gastroenterology, University of Alabama, Birmingham 35294.
Agents Actions Suppl. 1991;35:93-101.
This paper reviews recent data describing the increased risk of bleeding and peptic ulcer with NSAID use in arthritis and non-arthritis populations. We briefly report personal studies on both aspects. By objective testing in 66 GI bleeders the use of NSAIDs, especially ASA, was more strongly associated with GI bleeding from both ulcer and non-ulcer sources, including colonic, than previously reported (82% vs. 21% in controls). ASA abuse, often surreptitious, may account for many, if not most, treatment-resistant peptic ulcers. We report 29 such patients. Adverse effects of NSAID use add considerably to economic cost, excess morbidity and mortality, especially in the elderly. Bleeding and peptic ulcer are separate risks of NSAID use. This conclusion carries major implications for prophylaxis strategies.
本文回顾了近期的数据，这些数据描述了在关节炎患者和非关节炎人群中使用非甾体抗炎药（NSAID）导致出血和消化性溃疡风险增加的情况。我们简要报告了在这两个方面的个人研究。通过对66例胃肠道出血患者进行客观测试发现，使用NSAID，尤其是阿司匹林（ASA），与包括结肠在内的溃疡和非溃疡来源的胃肠道出血的关联比之前报道的更为强烈（与对照组的21%相比，使用NSAID导致胃肠道出血的比例为82%）。阿司匹林滥用（通常是隐匿性的）可能是许多（即使不是大多数）难治性消化性溃疡的原因。我们报告了29例此类患者。使用NSAID的不良反应显著增加了经济成本、额外的发病率和死亡率，尤其是在老年人中。出血和消化性溃疡是使用NSAID的独立风险。这一结论对预防策略具有重要意义。
