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Журнал "Клиническая геронтология"

Защита  слизистой оболочки  ЖКТ от повреждающего действия нестероидных противовоспалительных препаратов (Лекция)
Е.В. Голованова
ФГБОУ ВО  Московский государственный медико-стоматологический университет им. А.И. Евдокимовава, Минздрава России

Представлена актуальная тема защиты слизистой оболочки  желудочно-кишечного тракта при приеме нестероидных противовоспалительных препаратов, особенно у пациентов пожилого и старческого возраста. Побочное действие этих средств, широко и постоянно применяемых при ревматических болезнях, болевом синдроме различного генеза, для профилактики тромбоза и др., может быть клинически выраженным  и грозным , или бессимптомным, «немым». С целью профилактики НПВП-гастропатии и НПВП-энтеропатии  много лет используются ингибиторы протонной помпы, а в последнее время  и цитопротекторы, в частности эффективный и безопасный ребапимид.
Ключевые слова: нестероидные противовоспалительные средства, НПВП-гастропатия, НПВП-энтеропатия, ингибиторы протонной помпы,  цитопротекторы 
Авторы заявляют об отсутствии возможных конфликтов интересов


Protection of gastrointestinal mucosa from the damaging effect of nonsteroidal anti-inflammatory drugs (Lecture)
Е.V. Golovanova
FGBOU VO Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

We have presented the hot topic of protection of the mucous membrane of the gastrointestinal tract while taking non-steroidal anti-inflammatory drugs, especially in elderly patients. Side effects of these drugs, that are widely and consistently used in rheumatic diseases, pain syndromes of different origin, for the prevention of thrombosis, etc., may be symptomatic and menacing, or asymptomatic, "dumb." Guided by the aim prophlaxis of NSAID-gastropathy and enteropathy, proton pump inhibitors, and, more recently, cytoprotectors, are used for many years, particularly effective and safe seems to be rebapimid.
Keywords: non-steroidal anti-inflammatory drugs, NSAID-gastropathy, NSAID-enteropathy, proton pump inhibitors, cytoprotector
Authors declare  lack  of the possible conflicts  of interests

                                         Литература

  1. Дроздов В.Н. Гастропатии, вызванные нестероидными противовоспалительными препаратами: патогенез, профилактика и лечение. Гастроэнтерология: приложение к журналу Consilium medicum. 2005; 7(1).  
  2. Каратеев А.Е., Насонов Е.Л. НПВП-ассоциированная патология ЖКТ: реальное состояние дел в России. РМЖ. 2006;15: 1073–1078.
  3. Lanas A., Garcia-Rodriguez L.A., Arroyo M.T. et al. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut. 2006; 55: 1731–1738.
  4. Fries J. Non-steroidal anti-inflammatory drug safety: a view from the АRAMIS databank Curr. Op. Rheumatol. 1996; 9: 3–7.
  5. Hawkey C.J., Lаngstrom G., Naesdal J. et al. Significance of dyspeptic symptoms during healing and maintenance of NSAID associated gastroduodenal lesions with omeprazole, misoprostol and ranitidine Gastroenterol. 1997; 112:A144.
  6. Hawkey C.J., Lanas A.I. Doubt and certainty about non-steroidal anti-inflammatory drug in the year 2000: a multidisciplinary expert statement. Am. J. Med. 2001; 8 (110): 79–100.
  7. Singh G., Ramey D.R., Morfeld D. et al. Gastrointestinal tract complications of non-steroidal anti-inflammatory drug treatment in rheumatoid arthritis. Arch. Intern. Med. 1996; 156: 1530–1536.
  8. Rostom A., Dube C., Wells G. Prevention of NSAID-induced gastroduodenal ulcers (Cochrane Review). The Cochrane Library.  2004; Issue 2. Chichester, UK, John Wiley & Son, Ltd.
  9. Seager J.M., Hawkey CJ. ABC of the upper gastrointestinal tract: Indigestion and non-steroidal anti-inglammatory drugs. BMJ. 2001;323:1236–1239.
  10. Пахомова И.Г. и соавт.  Новости медицины и фармации. Гастроэнтерология. 2013. 
  11. Laine L. Rev Gastroenterol Disord; 2003: 3 (suppl 4):S30-9. Lanza Am. J. Gastroenterol. 2009.
  12. Merle V., Thiefin G., Czernichow P. Epidemiology of gastroduodenal complications associated with nonsteroidal anti-inflammatory drug  use Gastroenterol. Clin. Biol. 2004; 28: 27–36.
  13. Langman MJS, Morgan L., Worall A. Use of inflammatory drugs by patients admitted with small or large bowel perforations  and haemorrhage. Br. Med. J. 1985;290: 347–349.
  14. 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): 250–254.
  15. Bjarnason I., Smethurst P., Fenn C.G., Lee C.E., Menzies I.S., Levi J. Misoprostol reduces indomethacin– induced changes in human small intestinal permeability. Dig Dis Sci. 1989; 34: 407–411.
  16. Morris A.J., Wasson L.A., Mackenzie J.F. Small bowel enteroscopy in undiagnosed gastrointestinal blood loss. Gut. 1992; 887–889.
  17. Каратеев А.Е., Насонова В.А. Энтеропатия, индуцированная нестероидными противовоспалительными препаратами. Тер. арх. 2004.  2: 79-82.
  18. Bhatt et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use.  JACC. 2008; 52(18) :1502-1517.
  19. Tozawa K., Oshima T., Okugawa T., Ogawa T., Ohda Е ., Tomita T., Hida N., Fukui H., Hori K.,  Watari J., Nakamura S., Miwa H. A randomized, double-blind, placebo-controlled study of rebamipide for gastric mucosal injury taking aspirin with or without clopidogrel. Dig Dis Sci. 2014; 59(8):1885-1890.
  20. Mizukami K.l., Murakami K., Abe T., Inoue K., Uchida M., Okimoto T., Kodama M., Fujioka Т. Aspirin-induced small bowel injuries and the preventive effect of rebamipide.World. J. Gastroenterol. 2011; 14;17(46): 5117-5122. doi: 10.3748/wjg.v17.i46.5117.
  21. Zhang S., Qing Q., Bai Y. Rebamipide helpsd efend against nonsteroidal anti-inflammatory drugs induced gastroenteropathy:  A systematic review and meta-analysis. Dig. Dis. Sci. 2013;7:1991—2000.doi: 10.1007/s10620-013-2606-0.

                             References
1.Drozdov V.N. Gastropathy caused by non-steroidal anti-inflammatory drugs: pathogenesis, prevention and treatment. Gastroenterology: Supplement to Consilium medicum. 2005; 7 (1). (In Russ.).
2. Karateev AE, Nasonov EL NSAID-associated pathology of the gastrointestinal tract: the real state of affairs in Russia.RMG. 2006; 15: 1073-1078.(In Russ.).
3.Lanas A., Garcia-Rodriguez L.A., Arroyo M.T. et al. Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations. Gut. 2006; 55: 1731–1738.
4.Fries J. Non-steroidal anti-inflammatory drug safety: a view from the АRAMIS databank Curr. Op. Rheumatol. 1996; 9: 3–7.
5.Hawkey C.J., Lаngstrom G., Naesdal J. et al. Significance of dyspeptic symptoms during healing and maintenance of NSAID associated gastroduodenal lesions with omeprazole, misoprostol and ranitidine Gastroenterol. 1997; 112:A144.
6.Hawkey C.J., Lanas A.I. Doubt and certainty about non-steroidal anti-inflammatory drug in the year 2000: a multidisciplinary expert statement. Am. J. Med. 2001; 8 (110): 79–100.
7.Singh G., Ramey D.R., Morfeld D. et al. Gastrointestinal tract complications of non-steroidal anti-inflammatory drug treatment in rheumatoid arthritis. Arch. Intern. Med. 1996; 156: 1530–1536.
8.Rostom A., Dube C., Wells G. Prevention of NSAID-induced gastroduodenal ulcers (Cochrane Review). The Cochrane Library.  2004; Issue 2. Chichester, UK, John Wiley & Son, Ltd.
9.Seager J.M., Hawkey CJ. ABC of the upper gastrointestinal tract: Indigestion and non-steroidal anti-inglammatory drugs. BMJ. 2001;323:1236–1239.
10.Pakhomova IG et al. News of medicine and pharmacy. Gastroenterology. 2013.
11.Laine L. Rev Gastroenterol Disord; 2003: 3 (suppl 4):S30-9. Lanza Am. J. Gastroenterol. 2009.
12.Merle V., Thiefin G., Czernichow P. Epidemiology of gastroduodenal complications associated with nonsteroidal anti-inflammatory drug  use Gastroenterol. Clin. Biol. 2004; 28: 27–36.
13.Langman MJS, Morgan L., Worall A. Use of inflammatory drugs by patients admitted with small or large bowel perforations  and haemorrhage. Br. Med. J. 1985;290: 347–349.
14.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): 250–254.
Bjarnason I., Smethurst P., Fenn C.G., Lee C.E., Menzies I.S., Levi J. Misoprostol reduces indomethacin– induced changes in human small intestinal permeability. Dig Dis Sci. 1989; 34: 407–411.
16Morris A.J., Wasson L.A., Mackenzie J.F. Small bowel enteroscopy in undiagnosed gastrointestinal blood loss. Gut. 1992; 887–889.
17.Karateev AE, VA Nasonova Enteropathy induced by non-steroidal anti-inflammatory drugs. Ter. Arch. 2004. 2: 79-82. (In Russ.).
18. Bhatt et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use.  JACC. 2008; 52(18) :1502-1517.
19. Tozawa K., Oshima T., Okugawa T., Ogawa T., Ohda Е ., Tomita T., Hida N., Fukui H., Hori K.,  Watari J., Nakamura S., Miwa H. A randomized, double-blind, placebo-controlled study of rebamipide for gastric mucosal injury taking aspirin with or without clopidogrel. Dig Dis Sci. 2014; 59(8):1885-1890.
20. Mizukami K.l., Murakami K., Abe T., Inoue K., Uchida M., Okimoto T., Kodama M., Fujioka Т. Aspirin-induced small bowel injuries and the preventive effect of rebamipide.World. J. Gastroenterol. 2011; 14;17(46): 5117-5122. doi: 10.3748/wjg.v17.i46.5117.
21. Zhang S., Qing Q., Bai Y. Rebamipide helpsd efend against nonsteroidal anti-inflammatory drugs induced gastroenteropathy:  A systematic review and meta-analysis. Dig. Dis. Sci. 2013;7:1991—2000.doi: 10.1007/s10620-013-2606-0.



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