Goldstein Jay L, Cryer Byron
Department of Medicine, NorthShore University HealthSystem, Evanston, IL, USA.
Division of Gastroenterology, University of Texas Southwestern Medical Center and Dallas VA Medical Center, Dallas, TX, USA.
Drug Healthc Patient Saf. 2015 Jan 22;7:31-41. doi: 10.2147/DHPS.S71976. eCollection 2015.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective anti-inflammatory and analgesic agents and are among the most commonly used classes of medications worldwide. However, their use has been associated with potentially serious dose-dependent gastrointestinal (GI) complications such as upper GI bleeding. GI complications resulting from NSAID use are among the most common drug side effects in the United States, due to the widespread use of NSAIDs. The risk of upper GI complications can occur even with short-term NSAID use, and the rate of events is linear over time with continued use. Although gastroprotective therapies are available, they are underused, and patient and physician awareness and recognition of some of the factors influencing the development of NSAID-related upper GI complications are limited. Herein, we present a case report of a patient experiencing a gastric ulcer following NSAID use and examine some of the risk factors and potential strategies for prevention of upper GI mucosal injuries and associated bleeding following NSAID use. These risk factors include advanced age, previous history of GI injury, and concurrent use of medications such as anticoagulants, aspirin, corticosteroids, and selective serotonin reuptake inhibitors. Strategies for prevention of GI injuries include anti-secretory agents, gastroprotective agents, alternative NSAID formulations, and nonpharmacologic therapies. Greater awareness of the risk factors and potential therapies for GI complications resulting from NSAID use could help improve outcomes for patients requiring NSAID treatment.
非甾体抗炎药（NSAIDs）是有效的抗炎和镇痛药，也是全球最常用的药物类别之一。然而，其使用与潜在的严重剂量依赖性胃肠道（GI）并发症相关，如上消化道出血。由于NSAIDs的广泛使用，NSAIDs使用导致的GI并发症是美国最常见的药物副作用之一。即使短期使用NSAIDs也可能发生上消化道并发症的风险，并且随着持续使用，事件发生率随时间呈线性增加。尽管有胃保护疗法，但它们未得到充分利用，并且患者和医生对一些影响NSAID相关上消化道并发症发生的因素的认识和识别有限。在此，我们报告一例使用NSAIDs后发生胃溃疡的患者病例，并探讨一些危险因素以及预防NSAIDs使用后上消化道黏膜损伤和相关出血的潜在策略。这些危险因素包括高龄、既往GI损伤史以及同时使用抗凝剂（如阿司匹林、皮质类固醇和选择性5-羟色胺再摄取抑制剂）等药物。预防GI损伤的策略包括抗分泌剂、胃保护剂、替代NSAID制剂和非药物疗法。提高对NSAIDs使用导致的GI并发症的危险因素和潜在疗法的认识，可能有助于改善需要NSAID治疗的患者的预后。
