Kvasnovsky Charlotte L, Aujla Usman, Bjarnason Ingvar
Department of Colorectal Surgery, King's College Hospital , Denmark Hill, London SE5 9RS , UK.
Scand J Gastroenterol. 2015 Mar;50(3):255-63. doi: 10.3109/00365521.2014.966753. Epub 2014 Oct 14.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed analgesics for treatment of variety of pain and inflammatory conditions. Their effects on the gastrointestinal tract are well described, but their possible propensity to cause clinical relapse in patients with inflammatory bowel disease (IBD) remains somewhat unclear.
We reviewed case reports, case-control and cohort studies, as well as clinical trials of NSAIDs in patients with quiescent IBD in order to better assess the magnitude and type of effect.
The published literature on this subject is of mixed quality and many of the studies are open to criticism. The majority of patients with IBD tolerate these medications, while in the sole clinical trial of NSAIDs 20% experienced a clinical and laboratory documented relapse of disease, within 7-10 days of NSAID ingestion. The data on cyclooxygenase (COX)-2-selective anti-inflammatory analgesic are somewhat unclear, but nimesulide, celecoxib and etoricoxib do not appear to be associated with relapse of disease.
Conventional NSAIDs may cause clinical relapse in about 20% of patients with quiescent IBD, which may be due to dual inhibition of the COX enzymes. Certain COX-2-selective NSAIDs appear to be safe.
非甾体抗炎药（NSAIDs）是治疗各种疼痛和炎症性疾病最常用的处方镇痛药。其对胃肠道的影响已有充分描述，但其在炎症性肠病（IBD）患者中可能导致临床复发的倾向仍尚不清楚。
我们回顾了病例报告、病例对照研究和队列研究，以及NSAIDs用于静止期IBD患者的临床试验，以便更好地评估其影响的程度和类型。
关于该主题的已发表文献质量参差不齐，许多研究容易受到批评。大多数IBD患者耐受这些药物，而在NSAIDs的唯一一项临床试验中，20%的患者在摄入NSAIDs后7 - 10天内出现了临床和实验室记录的疾病复发。关于环氧化酶（COX）-2选择性抗炎镇痛药的数据尚不清楚，但尼美舒利、塞来昔布和依托考昔似乎与疾病复发无关。
传统NSAIDs可能导致约20%的静止期IBD患者临床复发，这可能是由于COX酶的双重抑制所致。某些COX-2选择性NSAIDs似乎是安全的。
