Davies N M
Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada.
Dis Colon Rectum. 1995 Dec;38(12):1311-21. doi: 10.1007/BF02049158.
Adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDS) on the upper gastrointestinal (GI) tract and small intestine are well described. Evidence is also accumulating that implicate NSAIDS in inducing and exacerbating damage in the distal GI tract. The purpose of this review is to identify possible adverse effects of NSAIDS on the large intestine and increase the clinical awareness of these toxicologic effects.
A literature review identified the diversity of toxicologic effects induced by NSAIDS in the large intestine. The epidemiology, pathogenesis, and clinical implications of these adverse effects are described.
NSAID use has been associated with colonic bleeding, iron deficiency anemia, strictures, ulcerations, perforations, diarrhea, and death. In addition, NSAIDS can exacerbate inflammatory bowel disease and ulcerative colitis. The prevalence of NSAID-induced large intestinal damage is unknown. Diagnosis can be made by colonoscopy and barium scans. Although the clinical presentation of NSAID-induced gastropathy and enteropathy, bleeding or perforation, may be more dramatic than colonopathy, the overall clinical significance of these adverse effects of NSAIDS on the large intestine has not been fully characterized.
This review illustrates that NSAID-induced large bowel toxicity can cause significant morbidity in some patients, ranging from profuse diarrhea, chronic blood loss, and iron deficiency anemia to fatality. The pathogenesis is likely multifactorial and is thought to be related to inhibition of prostaglandin synthesis. Because NSAIDS are widely prescribed and some are available without a prescription, heightened awareness of these toxicologic manifestations throughout the GI tract may reduce morbidity.
非甾体抗炎药（NSAIDs）对上消化道和小肠的不良反应已有充分描述。越来越多的证据表明，NSAIDs会引发并加剧下消化道的损伤。本综述的目的是确定NSAIDs对大肠可能产生的不良反应，并提高对这些毒理学效应的临床认识。
通过文献综述确定NSAIDs在大肠中诱发的毒理学效应的多样性。描述了这些不良反应的流行病学、发病机制及临床意义。
使用NSAIDs与结肠出血、缺铁性贫血、狭窄、溃疡、穿孔、腹泻及死亡相关。此外，NSAIDs会加重炎症性肠病和溃疡性结肠炎。NSAIDs诱发的大肠损伤的患病率尚不清楚。可通过结肠镜检查和钡剂扫描进行诊断。尽管NSAIDs诱发的胃病和肠病、出血或穿孔的临床表现可能比结肠病更显著，但NSAIDs对大肠的这些不良反应的整体临床意义尚未完全明确。
本综述表明，NSAIDs诱发的大肠毒性可在一些患者中导致严重发病，从严重腹泻、慢性失血、缺铁性贫血到死亡不等。其发病机制可能是多因素的，被认为与前列腺素合成的抑制有关。由于NSAIDs被广泛处方，且有些无需处方即可获得，提高对整个胃肠道这些毒理学表现的认识可能会降低发病率。
