Abstract
Aim. To assess the prevalence, structure, and features of aspirin-induced gastroduodenal lesions in patients with chronic coronary artery disease (CAD) and outline therapeutic options. Material and methods . The study included 340 patients with chronic CAD who received long-term low-dose acetylsalicylic acid (ASA) therapy. The diagnosis of chronic CAD was verified using a complex examination with selective coronary angiography (SCA). Further, esophagogastroduodenoscopy was performed in patients with chronic CAD to diagnose aspirin-induced gastroduodenal lesions. We also assessed their prevalence and structure. An endogenous prostaglandin-inducer rebamipide (300 mg daily) in combination with a proton pump inhibitor (PPI) pantoprazole were used to treat aspirin-induced gastroduodenal lesions. The comparison group consisted of patients with chronic CAD who received only pantoprazole. To clarify the pathogenesis of aspirin-induced gastroduodenal lesions before and after treatment, the levels of following serum pro-inflammatory cytokines were determined: interleukin-6 (IL-6), interleukin-1-beta (IL-1β), tumor necrosis factor alpha (TNF-α). The control group consisted of patients with chronic CAD and without signs of gastrointestinal lesions. Statistical processing was carried out using Statistica 10.0 software package. Results . Aspirin-induced gastroduodenal lesions were recorded in 15% of patients. Results of esophagogastroduodenoscopy revealed that gastric erosions of body and antrum prevailed among aspirin-induced lesions. The level of pro-inflammatory cytokines in these patients was significantly higher than in patients of control group. Therapy with PPI resulted in a positive endoscopic response in 19 of 25 patients and a slight decrease in cytokines. Combination of PPI with rebamipide led to mucosal reconstruction in all subjects and a statistically significant decrease in levels of serum pro-inflammatory cytokines. Conclusion. The current study showed aspects of development and possible therapeutic options in aspirin-induced gastrointestinal lesions in patients with chronic CAD.
Highlights
Aspirin-induced gastroduodenal lesions were recorded in 15% of patients
The current study showed aspects of development and possible therapeutic options in aspirin-induced gastrointestinal lesions in patients with chronic coronary artery disease (CAD)
5. Karateev AE, Nasonov EL, Yakhno NN, et al Clinical recommendations “Rational use of non-steroidal anti-inflammatory drugs (NSAIDs) in clinical practice”
Summary
The study included 340 patients with chronic CAD who received long-term low-dose acetylsalicylic acid (ASA) therapy. Esophagogastroduodenoscopy was performed in patients with chronic CAD to dia gnose aspirin-induced gastroduodenal lesions. The current study showed aspects of development and possible therapeutic options in aspirin-induced gastrointestinal lesions in patients with chronic CAD. V. Aspirin-induced gastrointestinal lesions in patients with chronic coronary artery disease: special aspects and therapeutic options. На сегодняшний день назначение АСК является обязательным компонентом терапии ИБС. Существующие способы защиты слизистой оболочки ЖКТ от воздействия АСК и других НПВП на сегодняшний день не находят своей абсолютной эффективности. В настоящее время идет активный поиск путей защиты слизистой оболочки ЖКТ при длительном применении АСК и других НПВП. В российских клинических рекомендациях “Рациональное использование нестероидных противовоспалительных препаратов” ребамипид рекомендован для профилактики осложнений, связанных с приемом НПВП (в т. ч. аспирининдуцированных патологий), со стороны верхних отделов ЖКТ, тонкой и толстой кишки [15]
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