International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Antiinflammatory Drugs Induced Gastropathy-ICON-G.

Ramesh Gn,Khin S Aye,Yurii M Stepanov,Baurzhan S Iskakov,Amit Garg,Reidwaan Ally,Richard Hunt,Mircea Manuc,Dmitry S Bordin,Yury C Marakhouski,Leonid B Lazebnik,Abror A Khamraev,Natalia V Bakulina

doi:10.5005/jp-journals-10018-1281

Abstract

IntroductionNonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. To help primary care physicians deal with such challenges more effectively, a panel of expert gastroenterologists came together with the aim of developing practice recommendations.MethodsA modified ‘Delphi’ process was used to reach consensus and develop practice recommendations. Twelve gastroenterologists from nine countries provided their expert inputs to formulate the recommendations. These recommendations were carefully developed taking into account existing literature, current practices, and expert opinion of the panelists.ResultsThe expert panel developed a total of fifteen practice recommendations. Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events.Conclusion/clinical significanceThese practice recommendations will serve as an important tool for primary care physicians and will guide them in making appropriate therapeutic choices for their patients.How to cite this article: Hunt R, Lazebnik LB, Marakhouski YC, Manuc M, Ramesh GN, Aye KS, Bordin DS, Bakulina NV, Iskakov BS, Khamraev AA, Stepanov YM, Ally R, Garg A. International Consensus on Guiding Recommendations for Management of Patients with Nonsteroidal Anti-inflammatory Drugs Induced Gastropathy-ICON-G. Euroasian J Hepatogastroenterol, 2018;8(2):148-160.

Highlights

Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events
Following are the key recommendations: NSAIDs should be prescribed only when necessary; before prescribing NSAIDs, associated modifiable and non-modifiable risk factors should be considered; H. pylori infection should be considered and treated before initiating NSAIDs; patients should be properly educated regarding NSAIDs use; patients who need to be on long-term NSAIDs should be prescribed a gastroprotective agent, preferably a proton pump inhibitor and these patients should be closely monitored for any untoward adverse events
While NSAIDs are associated with renal and cardiovascular adverse events (AEs), the most common are gastrointestinal (GI) complications, which includegastritis, ulcers, perforation, and enteropathy.3,4A study from Denmark reported an increase in the prevalence of NSAID-related peptic ulcers from 39% in 1993 to 53% in 2002.5 Further, the point prevalence of GI complications related to NSAID exposure in the Indian subcontinent in the year 2014 was found to be 30%

Summary

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs), one of the most commonly used medications worldwide, are frequently associated with gastrointestinal adverse events. Primary care physicians often face the challenge of achieving adequate pain relief with NSAIDs, while keeping their adverse events to a minimum. This is especially true when long-term use of NSAIDs is required such as in patients with osteoarthritis and rheumatoid arthritis. The NSAID-induced gastropathy (NIG) develops at doses that inhibit prostaglandin production, enhance gastric motility, and increase mucosal permeability. This results in neutrophil infiltration and free radical production, and eventually mucosal lesions.[9] Risk factors include increasing age, the presence of comorbidities especially a history of peptic ulcer disease, liver cirrhosis, and cardiovascular disease. Long-term use of NSAIDs, Helicobacter pylori (H. pylori) infection, smoking, chronic alcohol abuse, and concomitant use of other medications increase the risk of developing NIG.[3,10,11,12,13]

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Conclusion