摘要:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the mainstay of treatment for rheumatic diseases. However, a significant number of patients receiving these drugs experience upper gastrointestinal side effects, including physical injury to the gastroduodenal mucosa. This may range from clinically insignificant bleeding and minor erosive changes to deeper ulceration, with attendant risk of haemorrhage or perforation. The majority of the published literature concerning healing of NSAID-associated peptic ulcer with antisecretory drugs involves studies of the use of the H2-receptor antagonists, ranitidine and cimetidine. Peptic ulcers associated with NSAID use can be healed with these H2-receptor antagonists using the same doses as those used for healing of idiopathic gastric or duodenal ulceration. Most ulcers heal within 4-8 weeks in those patients who are able to discontinue their anti-inflammatory therapy. If the NSAID is continued, healing may be slightly delayed. At present, limited data only are available with respect to the use of the proton pump inhibitor, omeprazole, and no firm conclusions can be drawn regarding the use of the prostaglandin analogue, misoprostol, for the healing of NSAID-associated peptic ulceration.

ISSN:0257-2753    

DOI:10.1159/000171528

出版商:S. Karger AG    

年代:1995

数据来源: Karger

摘要:

The risk of gastrointestinal bleeding or perforation during NSAID use is unquestionably increased. The need for emergency surgery as well as mortality is also increased in NSAID users as compared to nonusers. However, the magnitude of these risks still remains imprecise. There is a lot of controversy about the role of predisposing factors such as age, sex, past history of peptic ulcer disease, dyspepsia or infection by Helicobacter pylori. The bleeding risk seems to be related to NSAID dosage, but not to the duration of treatment. The location most at risk varies from one study to another with no significant difference between gastric and duodenal ulcers. Bleeding severity or mortality rate do not differ according to whether NSAIDs are used or not. General treatment principles of peptic ulcer bleeding as well as the role of endoscopic hemostasis, drug therapy or surgery are emphasized. The role of subsequent treatment after hemostasis and the rules for prophylaxis are also discussed.

ISSN:0257-2753    

DOI:10.1159/000171529

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171532

出版商:S. Karger AG    

年代:1995

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171524

出版商:S. Karger AG    

年代:1995

数据来源: Karger