Avances en patología gastrointestinal relacionada con el tratamiento con antiinflamatorios no esteroideos y antiagregantes plaquetarios

Abstract

The most important and recent advance reported in the field of the non-steroidal antiinflammatory drug (NSAID)-associated gastrointestinal (GI) lesions is the CONDOR study. This study shows that treatment with celecoxib 200 mg/12 hours is associated with a lower frequency of clinically significant adverse effects throughout the GI tract when compared with treatment with diclofenac 75 mg/12 hours + omeprazole 20 mg/day in at-risk patients with osteoarthritis or rheumatoid arthritis. Other studies of interest report that most arthritis patients requiring NSAIDs are at increased GI and cardiovascular risk and that more than 50% do not receive appropriate therapy based on current recommendations. Recent epidemiological studies confirm that aspirin use, alone or associated with other antiplatelet agents, is associated with increased risk of GI bleeding from either the upper or the lower GI tract, and that proton pump inhibitors (PPIs) reduce the risk of upper GI bleeding. The most recent data also question the negative interaction between PPI and clopidogrel, but the data are still generally of low quality. A notable new compound is cobiprostone, a local chloride channel activator. When combined with NSAIDs, this agent reduces the occurrence of gastric lesions. Another new agent that combines aspirin with phosphatidylcholine is associated with a lower degree of gastroduodenal mucosal damage than aspirin and has identical antiplatelet effect to aspirin alone.