Features of management of patientswith NSAID-induced gastropathy: from understanding the mechanisms of development to the strategy of prevention and treatment. Risks of short-term use of non-steroidal anti-inflammatory drugs. Part I

Abstract

Nonsteroidal anti‑inflammatory drugs (NSAIDs) is a big group of medications with different chemical structure but common mechanisms of pharmacological actions and ability to provide analgesic, anti‑inflammatory and antipyretic effects. NSAIDs is one of the therapeutically instruments to relief acute and chronic pain at a wide spectrum of diseases and pathological conditions. NSAIDs administration is an integral part of the work of physicians, rheumatologists, neurologists, anesthesiologists, surgeons, traumatologists, gynecologists and other medical specialties. NSAIDs are effective and easy to use, but they can cause serious complications and first of all, the gastrointestinal adverse events.The paper present analysis of the structure of drug‑induced injuries of upper gastrointestinal tract in patients taking NSAIDs. The risks of adverse events that develop against the background of short‑term NSAIDs use for analgesic, anti‑inflammatory, antipyretic purposes have been discussed. The data on the frequency and features of clinical, endoscopic and morphological manifestations of NSAID‑gastropathies are presented. The danger of these complications, which may be accompanied by life‑threatening conditions such as bleeding or perforation, has been demonstrated. The role of modern endoscopic methods for the diagnosis of NSAID‑gastropathies is evaluated. Based on a clinical example, the authors proposed a strategy for the prevention and treatment of NSAID‑gastropathy, which arose against the background of asymptomatic Helicobacter pylori infection. Current data on various strategies for the treatment and prevention of NSAID gastropathies are presented. Based on the analysis, it has been concluded that the use of proton pump inhibitors (PPIs) and the eradication of Helicobacter pylori infection are the best strategies. The use of double doses of PPIs makes it possible to increase the effectiveness of prevention and treatment of NSAID‑gastropathies, as well as eradication therapy.