Hunt Richard, B Lazebnik Leonid, C Marakhouski Yury, Manuc Mircea, Gn Ramesh, S Aye Khin, S Bordin Dmitry, V Bakulina Natalia, S Iskakov Baurzhan, A Khamraev Abror, M Stepanov Yurii, Ally Reidwaan, Garg Amit
Department of Medicine, McMaster University Health Science Centre, Hamilton, Ontario, Canada.
Hospital Therapy, Moscow State University of Medicine and Dentistry, Moscow, Russian Federation.
Euroasian J Hepatogastroenterol. 2018 Jul-Dec;8(2):148-160. doi: 10.5005/jp-journals-10018-1281. Epub 2019 Feb 1.
Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations.
A modified 'Delphi' process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists.
The expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events.
CONCLUSION/CLINICAL SIGNIFICANCE: These practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients. Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160.
非甾体抗炎药（NSAIDs）是全球最常用的药物之一，常与胃肠道不良事件相关。基层医疗医生经常面临着使用NSAIDs实现充分止痛，同时将其不良事件降至最低的挑战。在需要长期使用NSAIDs的情况下，如骨关节炎和类风湿关节炎患者，尤其如此。为帮助基层医疗医生更有效地应对此类挑战，一组专家胃肠病学家共同努力制定实践建议。
采用改良的“德尔菲”法达成共识并制定实践建议。来自9个国家的12名胃肠病学家提供了他们的专业意见以制定这些建议。这些建议是在考虑现有文献、当前实践以及小组成员的专业意见的基础上精心制定的。
专家小组共制定了15条实践建议。以下是关键建议：仅在必要时开具NSAIDs；在开具NSAIDs之前，应考虑相关的可改变和不可改变的风险因素；在开始使用NSAIDs之前应考虑并治疗感染；应就NSAIDs的使用对患者进行适当教育；需要长期使用NSAIDs的患者应开具胃保护剂，最好是质子泵抑制剂，并且应对这些患者密切监测任何不良事件。
结论/临床意义：这些实践建议将成为基层医疗医生的重要工具，并指导他们为患者做出适当的治疗选择。亨特R、拉泽布尼克LB、马拉霍夫斯基YC、马努克M、拉梅什GN、艾KS、博尔丁DS、巴库利纳NV、伊斯卡科夫BS、哈姆拉耶夫AA、斯捷潘诺夫YM、艾利R、加尔格A。非甾体抗炎药所致胃病患者管理指导建议的国际共识——ICON - G。《欧亚肝脏胃肠病学杂志》，2018年；8(2)：148 - 160。
