Arora Gaurav, Singh Gurkirpal, Triadafilopoulos George
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305-5187, USA.
Clin Gastroenterol Hepatol. 2009 Jul;7(7):725-35. doi: 10.1016/j.cgh.2009.03.015. Epub 2009 Mar 21.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are among the most commonly used medications worldwide. Their use is associated with significant gastroduodenal adverse effects, including dyspepsia, bleeding, ulcer formation, and perforation. Given their long-term use by millions of patients, there is a substantial impact at the population level of these complications. In this evidence-based review, we have endeavored to answer 12 commonly encountered questions in clinical practice that deal with the following: extent of the problem of NSAID/aspirin-induced gastroduodenal damage and its impact on public health; role of proton pump inhibitors (PPIs) in the primary prevention, healing, and secondary prevention of NSAID/aspirin-induced gastroduodenal ulceration as assessed by using endoscopic end points; role of PPIs in the prevention of adverse clinical outcomes related to NSAID/aspirin use; whether PPIs are effective in NSAID-induced dyspepsia; comparison of PPI co-therapy with selective cyclooxygenase-2 inhibitors for risk reduction of adverse clinical outcomes; role of PPIs in preventing rebleeding from aspirin +/- clopidogrel therapy in high-risk patients; identifying high-risk patients who can benefit from PPI co-therapy; the role of other gastroprotective agents for prevention of NSAID/aspirin-induced gastroduodenal damage; and the cost-effectiveness of and limitations to the use of PPIs for prevention of gastroduodenal damage related to the use of NSAIDs or aspirin. We then summarized our recommendations on the use of PPIs for the clinical management of patients using NSAIDs or aspirin.
非甾体抗炎药（NSAIDs）和阿司匹林是全球最常用的药物之一。它们的使用与显著的胃十二指肠不良反应相关，包括消化不良、出血、溃疡形成和穿孔。鉴于数百万患者长期使用这些药物，这些并发症在人群层面产生了重大影响。在这篇循证综述中，我们力图回答临床实践中12个常见问题，这些问题涉及以下方面：NSAID/阿司匹林所致胃十二指肠损伤问题的严重程度及其对公众健康的影响；通过内镜检查终点评估质子泵抑制剂（PPIs）在NSAID/阿司匹林所致胃十二指肠溃疡的一级预防、愈合及二级预防中的作用；PPIs在预防与NSAID/阿司匹林使用相关的不良临床结局中的作用；PPIs对NSAID所致消化不良是否有效；PPI联合治疗与选择性环氧化酶-2抑制剂在降低不良临床结局风险方面的比较；PPIs在预防高危患者阿司匹林±氯吡格雷治疗引起的再出血中的作用；识别可从PPI联合治疗中获益的高危患者；其他胃保护剂在预防NSAID/阿司匹林所致胃十二指肠损伤中的作用；以及使用PPIs预防与使用NSAIDs或阿司匹林相关的胃十二指肠损伤的成本效益和局限性。然后，我们总结了关于使用PPIs对使用NSAIDs或阿司匹林患者进行临床管理的建议。
