nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2405nnp-184Research ArticleArticlesСтатьиAnti-inflammatory drug-induced injury to the intestinal tube: clinical value, pathogenesis, possibilities of preventionПовреждение кишечной трубки нестероидными противовоспалительными препаратами: клиническое значение, патогенез, возможности профилактикиEvseevMaksim AleksandrovichEvseevMaksim Aleksandrovich

Department of General Surgery

Department of General Surgery

Dr.maxim.evseev@gmail.com20131503201351NO1 (2013)7987Copyright © Evseev M.A., 20132013Evseev M.A.Evseev M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/184

Enteropathy induced by nonsteroidal anti-inflammatory drugs (NSAIDs) is a socially and clinically highly significant pathological process in terms of its epidemiology and consequences. Understanding of the seriousness of this problem requires that the occurrence and course of a pathological process in the small bowel should be controlled in the use of NSAIDs, on the one hand, and enables purposeful and pathogenetically sound prevention of NSAID-induced enteropathy on the other. At the same time, protection of not only the small bowel, but the entire digestive tube may be provided in full measure only when the protective potential of the mucosa is preserved. Coxibs, selective cyclooxygenase 2 inhibitors, that are safe for the digestive tubal mucosa, should be used as agents for the primary prevention of NSAID-induced injury.

Энтеропатия, индуцированная нестероидными противовоспалительными препаратами (НПВП), с точки зрения эпидемиологии и последствий представляет собой социально и клинически весьма значимый патологический процесс. Понимание серьезности данной проблемы требует, с одной стороны, осуществления контроля за возникновением и течением патологического процесса в тонкой кишке на фоне приема НПВП, а с другой — позволяет проводить целенаправленную и патогенетически обоснованную профилактику НПВП-индуцированной энтеропатии. При этом защита не только тонкой кишки, но и всей пищеварительной трубки в полной мере может быть обеспечена только при сохранении защитного потенциала слизистой оболочки. В качестве средств первичной профилактики НПВП-индуцированного поражения необходимо использовать безопасные в отношении слизистой оболочки пищеварительной трубки селективные ингибиторы циклооксигеназы 2 — коксибы.

нестероидные противовоспалительные препаратыНПВП-индуцированная энтеропатияпатогенезпрофилактикаnonsteroidal anti-inflammatory drugsNSAID-induced enteropathypathogenesispreventionReferences<div><p>Bjarnason I., Zanelli G., Prouse P. et al. Effect of non-steroidal anti-inflammatory drugs on the human small intestine. Drugs 1986;32(Suppl):35-41.</p><p>Langman M.J.S., Morgan L., Worall A. Use of inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J 1985;290:347-9.</p><p>Morris A.J., Wasson L.A., Mackenzie J.F. Small bowel enteroscopy in undiagnosed gastrointestinal blood loss. Gut 1992;887—9.</p><p>Kessler W.F., Shires G.T. 3rd, Fahey T.J. 3rd. Surgical complications of nonsteroidal antiinflammatory drug-induced small bowel ulceration. J Am Coll Surg 1997;185(3):250-4.</p><p>Allison M.C., Howatson A.G., Torrance C.J. et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med 1992;327:751-6.</p><p>Евсеев М.А., Круглянский Ю.М. НПВП-индуцированная энтеропатия: особенности эпидемиологии, патогенеза и клинического течения РМЖ 2008;7:523-8.</p><p>Whittle B.J.R., Vane J.R. A biochemical basis for the gastrointestinal toxicity of non-steroid anti-rheumatoid drugs. Arch Toxicol 1984 (Suppl);7:315-22.</p><p>Davies N.M., Roseth A.G., Appleyard C.B. et al. No-naproxen vs. naproxen: ulcerogenic, analgesic and anti-inflammatory effects. Aliment Pharmacol Ther 1997;11:69-79.</p><p>Miura S., Suematsu M., Tanaka S. Microcirculatory disturbance in indomethacin-induced intestinal ulcer. Am J Physiol 1991;261:G213-G219.</p><p>Reuter B.K., Davies N.M., Wallace J.L. Nonsteroidal anti-inflammatory drug enteroapthy in rats: role of permeability, bacteria, and enterohepatic recirculation. Gastroenterology 1997;112:109-17.</p><p>Bjarnason I., Hayllar J., Macpherson A.J., Russell A.S. Side effects of nonsteroidal antiinflammatory drugs on the small and large intestine in humans. Gastroenterology 1993; 104:1832—47.</p><p>Gaede P.H., Helmsoe-Zinck L., Brynskov J. Diaphragm-like strictures of the small intestine after treatment with non-steroidal anti-inflammatory agents. Ugeskr Laeger 1993;155:2409-11.</p><p>Matsuhashi N., Yamada A., Hiraishi M. et al. Multiple strictures of the small intestine after long-term nonsteroidal anti-inflammatory drug therapy. Am J Gastroent 1993;87:1183-6.</p><p>Saverymuttu S.H., Thomas A., Grundy A., Maxwell J.D. Ileal stricturing after long-term indomethacin treatment. Postgrad Med J 1986;62:967—8.</p><p>Sturges H.F., Krone C.L. Ulceration and stricture of the jejunum in a patient on longterm indomethacin therapy. Am J Gastroenterol 1973;59:162—9.</p><p>Mo Adam B.F., Catella-Lawson E., Mardini I.A. et al. Systemic biosynthesis of prostacyclin by cyclooxigenase (COX)-2: the human pharmacology of a selective inhibitors of COX-2. PNAS 1999;96:272-7.</p><p>Collins A.J., Du Toit J.A. Upper gastrointestinal findings and faecal occult blood in patients with rhumatic diseases taking nonsteroidal anti-inflmmatory drugs. Br J Rheumatol 1987;26:295-8.</p><p>Holt S., Rigoglioso V., Sidhu M. et al. Nonsteroidal anti-inflammatory drugs and lower gastrointestinal bleeding. Dig Dis Sci 1993;38:1619—23.</p><p>Bjarnason I., Prouse P., Smith T. et al. Blood and protein loss via small intestinal inflammation induced by non-steroidal antiinflammatory drugs. Lancet 1987;2:711-4.</p><p>Bjarnason I., Zanelli G., Smith T. et al. Nonsteroidal anti-inflammatory drug-induced intestinal inflammation in humans. Gastroenterology 1987;93:480-9.</p><p>Bjarnason I., Zanelli G., Smith T. et al. The pathogenesis and consequence of nonsteroidal anti-inflammatory drug induced small intestinal inflammation. Scand J Rheum Suppl 1987;64:55-62.</p><p>Fries J.F. NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal. J Rheum 2000;58(Suppl 28):6—10.</p><p>Goldstein J.L., Silverstein F.E., Agrawal N.M. et al. Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor. Am J Gastroenterol 2000;95:1681—90.</p><p>Aabakken L., Larsen S., Osnes M. Sucralfate for prevention of naproxen-induced mucosal lesions in the proximal and distal gastrointestinal tract. Scand J Rheum 1989;18:361—8.</p><p>Aabakken L., Larsen S., Osnes M. Cimetidine tablets or suspension for the prevention of gastrointestinal mucosal lesions caused by non-steroidal anti-inflammatory drugs. Scand J Rheum 1989;18:369-75.</p><p>Bjarnason I., Smethurst P., Fenn C.G. et al. Misoprostol reduces indomethacin- induced changes in human small intestinal permeability. Dig Dis Sci 1989;34:407-11.</p><p>Bjarnason I. Experimental evidence of the benefit of misoprostol beyond the stomach in humans. J Rheum 1990 (Suppl 20);17:38—41.</p><p>Davies G.R., Wilkie M.E., Rampton D.S. Effects of metronidazole and misoprostol on indomethacin-induced changes in intestinal permeability. Dig Dis Sci 1993;38:417-25.</p><p>Jenkins R.T., Rooney P.J., Hunt R.H. Increased bowel permeability to [51Cr]EDTA in controls caused by Naproxen is not prevented by cytoprotection. Arth Rheum 1988;31 (Suppl 1):R11.</p><p>Hayllar J., Smith T., Macpherson A. et al. Nonsteroidal antiinflammatory drug-induced small intestinal inflammation and blood loss. Effects of sulfasalazine and other disease-modifying antirheumatic drugs. Arthr Rheum 1994;37:1146—50.</p><p>Chan F.K.L., Cryer B., Goldstein J.L. et al. A novel composite endpoint to evaluate the gastrointestinal (GI) efects of nonsteroidal antiin-fammatory drugs through the entire GI tract. J Rheum 2010;37:167-74.</p></div><br /><div><p>Bjarnason I., Zanelli G., Prouse P. et al. Effect of non-steroidal anti-inflammatory drugs on the human small intestine. Drugs 1986;32(Suppl):35-41.</p><p>Langman M.J.S., Morgan L., Worall A. Use of inflammatory drugs by patients admitted with small or large bowel perforations and haemorrhage. Br Med J 1985;290:347-9.</p><p>Morris A.J., Wasson L.A., Mackenzie J.F. Small bowel enteroscopy in undiagnosed gastrointestinal blood loss. Gut 1992;887—9.</p><p>Kessler W.F., Shires G.T. 3rd, Fahey T.J. 3rd. Surgical complications of nonsteroidal antiinflammatory drug-induced small bowel ulceration. J Am Coll Surg 1997;185(3):250-4.</p><p>Allison M.C., Howatson A.G., Torrance C.J. et al. Gastrointestinal damage associated with the use of nonsteroidal antiinflammatory drugs. N Engl J Med 1992;327:751-6.</p><p>Евсеев М.А., Круглянский Ю.М. НПВП-индуцированная энтеропатия: особенности эпидемиологии, патогенеза и клинического течения РМЖ 2008;7:523-8.</p><p>Whittle B.J.R., Vane J.R. A biochemical basis for the gastrointestinal toxicity of non-steroid anti-rheumatoid drugs. Arch Toxicol 1984 (Suppl);7:315-22.</p><p>Davies N.M., Roseth A.G., Appleyard C.B. et al. No-naproxen vs. naproxen: ulcerogenic, analgesic and anti-inflammatory effects. Aliment Pharmacol Ther 1997;11:69-79.</p><p>Miura S., Suematsu M., Tanaka S. Microcirculatory disturbance in indomethacin-induced intestinal ulcer. Am J Physiol 1991;261:G213-G219.</p><p>Reuter B.K., Davies N.M., Wallace J.L. Nonsteroidal anti-inflammatory drug enteroapthy in rats: role of permeability, bacteria, and enterohepatic recirculation. Gastroenterology 1997;112:109-17.</p><p>Bjarnason I., Hayllar J., Macpherson A.J., Russell A.S. Side effects of nonsteroidal antiinflammatory drugs on the small and large intestine in humans. Gastroenterology 1993; 104:1832—47.</p><p>Gaede P.H., Helmsoe-Zinck L., Brynskov J. Diaphragm-like strictures of the small intestine after treatment with non-steroidal anti-inflammatory agents. Ugeskr Laeger 1993;155:2409-11.</p><p>Matsuhashi N., Yamada A., Hiraishi M. et al. Multiple strictures of the small intestine after long-term nonsteroidal anti-inflammatory drug therapy. Am J Gastroent 1993;87:1183-6.</p><p>Saverymuttu S.H., Thomas A., Grundy A., Maxwell J.D. Ileal stricturing after long-term indomethacin treatment. Postgrad Med J 1986;62:967—8.</p><p>Sturges H.F., Krone C.L. Ulceration and stricture of the jejunum in a patient on longterm indomethacin therapy. Am J Gastroenterol 1973;59:162—9.</p><p>Mo Adam B.F., Catella-Lawson E., Mardini I.A. et al. Systemic biosynthesis of prostacyclin by cyclooxigenase (COX)-2: the human pharmacology of a selective inhibitors of COX-2. PNAS 1999;96:272-7.</p><p>Collins A.J., Du Toit J.A. Upper gastrointestinal findings and faecal occult blood in patients with rhumatic diseases taking nonsteroidal anti-inflmmatory drugs. Br J Rheumatol 1987;26:295-8.</p><p>Holt S., Rigoglioso V., Sidhu M. et al. Nonsteroidal anti-inflammatory drugs and lower gastrointestinal bleeding. Dig Dis Sci 1993;38:1619—23.</p><p>Bjarnason I., Prouse P., Smith T. et al. Blood and protein loss via small intestinal inflammation induced by non-steroidal antiinflammatory drugs. Lancet 1987;2:711-4.</p><p>Bjarnason I., Zanelli G., Smith T. et al. Nonsteroidal anti-inflammatory drug-induced intestinal inflammation in humans. Gastroenterology 1987;93:480-9.</p><p>Bjarnason I., Zanelli G., Smith T. et al. The pathogenesis and consequence of nonsteroidal anti-inflammatory drug induced small intestinal inflammation. Scand J Rheum Suppl 1987;64:55-62.</p><p>Fries J.F. NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal. J Rheum 2000;58(Suppl 28):6—10.</p><p>Goldstein J.L., Silverstein F.E., Agrawal N.M. et al. Reduced risk of upper gastrointestinal ulcer complications with celecoxib, a novel COX-2 inhibitor. Am J Gastroenterol 2000;95:1681—90.</p><p>Aabakken L., Larsen S., Osnes M. Sucralfate for prevention of naproxen-induced mucosal lesions in the proximal and distal gastrointestinal tract. Scand J Rheum 1989;18:361—8.</p><p>Aabakken L., Larsen S., Osnes M. Cimetidine tablets or suspension for the prevention of gastrointestinal mucosal lesions caused by non-steroidal anti-inflammatory drugs. Scand J Rheum 1989;18:369-75.</p><p>Bjarnason I., Smethurst P., Fenn C.G. et al. Misoprostol reduces indomethacin- induced changes in human small intestinal permeability. Dig Dis Sci 1989;34:407-11.</p><p>Bjarnason I. Experimental evidence of the benefit of misoprostol beyond the stomach in humans. J Rheum 1990 (Suppl 20);17:38—41.</p><p>Davies G.R., Wilkie M.E., Rampton D.S. Effects of metronidazole and misoprostol on indomethacin-induced changes in intestinal permeability. Dig Dis Sci 1993;38:417-25.</p><p>Jenkins R.T., Rooney P.J., Hunt R.H. Increased bowel permeability to [51Cr]EDTA in controls caused by Naproxen is not prevented by cytoprotection. Arth Rheum 1988;31 (Suppl 1):R11.</p><p>Hayllar J., Smith T., Macpherson A. et al. Nonsteroidal antiinflammatory drug-induced small intestinal inflammation and blood loss. Effects of sulfasalazine and other disease-modifying antirheumatic drugs. Arthr Rheum 1994;37:1146—50.</p><p>Chan F.K.L., Cryer B., Goldstein J.L. et al. A novel composite endpoint to evaluate the gastrointestinal (GI) efects of nonsteroidal antiin-fammatory drugs through the entire GI tract. J Rheum 2010;37:167-74.</p></div><br />

The authors declare that there are no conflicts of interest present.