Lué Alberto, Lanas Angel
Alberto Lué, Angel Lanas, Digestive Diseases Service, University Clinic Hospital Lozano Blesa, Avenida San Juan Bosco, 50009 Zaragoza, Spain.
World J Gastroenterol. 2016 Dec 28;22(48):10477-10481. doi: 10.3748/wjg.v22.i48.10477.
Proton pump inhibitors (PPIs) represent a milestone in the treatment of acid-related diseases, and are the mainstay in preventing upper gastrointestinal bleeding in high-risk patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin. However, this beneficial effect does not extend to the lower gastrointestinal tract. PPIs do not prevent NSAID or aspirin-associated lower gastrointestinal bleeding (LGB). PPIs may increase both small bowel injury related to NSAIDs and low-dose aspirin treatment and the risk of LGB. Recent studies suggested that altering intestinal microbiota by PPIs may be involved in the pathogenesis of NSAID-enteropathy. An increase in LGB hospitalization rates may occur more frequently in older patients with more comorbidities and are associated with high hospital resource utilization, longer hospitalization, and increased mortality. Preventive strategies for NSAID and aspirin-associated gastrointestinal bleeding should be directed toward preventing both upper and lower gastrointestinal damage. Future research should be directed toward identifying patients at low-risk for gastrointestinal events associated with the use of NSAIDs or aspirin to avoid inappropriate PPI prescribing. Alternatively, the efficacy of new pharmacologic strategies should be evaluated in high-risk groups, with the aim of reducing the risk of both upper and lower gastrointestinal bleeding in these patients.
质子泵抑制剂（PPIs）是治疗酸相关疾病的一个里程碑，也是预防使用非甾体抗炎药（NSAIDs）或低剂量阿司匹林治疗的高危患者上消化道出血的主要药物。然而，这种有益效果并不适用于下消化道。PPIs不能预防NSAIDs或阿司匹林相关的下消化道出血（LGB）。PPIs可能会增加与NSAIDs和低剂量阿司匹林治疗相关的小肠损伤以及LGB的风险。最近的研究表明，PPIs改变肠道微生物群可能参与了NSAID肠病的发病机制。LGB住院率的增加在合并症较多的老年患者中可能更频繁发生，并且与高医院资源利用率、更长的住院时间和死亡率增加相关。NSAIDs和阿司匹林相关胃肠道出血的预防策略应旨在预防上消化道和下消化道损伤。未来的研究应致力于识别使用NSAIDs或阿司匹林相关胃肠道事件低风险的患者，以避免不适当的PPI处方。或者，应在高危人群中评估新的药物策略的疗效，目的是降低这些患者上消化道和下消化道出血的风险。
