Influence of Microbiota on NSAID Enteropathy: A Systematic Review of Current Knowledge and the Role of Probiotics

Abstract

Microbiota are increasingly studied, providing more precise information on their important role in physiologic processes. They also influence some pathologic processes, such as NSAIDinduced enteropathy. This side effect is much more diffuse than it has been described in the past. It derives mainly from the local action of the medicines and is caused by the local binding of gram-negative bacterial lipopolysaccharides and infiltration of neutrophils into the intestinal mucosa. The initial interest in the interaction between these damages and microbiota is very old, but new and interesting data are available. This review aims to focus on recent studies on NSAID-induced enteropathy, an often-underestimated medical condition, and on the influence of microbiota on this condition. Apart from the broadly investigated use of antibiotics and other mucosal protective solutions, this systematic review focuses mostly on the use of probiotics, which directly influence intestinal microflora. Other important factors influencing NSAID-induced enteropathy, such as sex, advanced age, infection and use of proton pump inhibitors, are also discussed.

Prominent Indomethacin-Induced Enteropathy in Fcgriib Defi-cient lupus Mice: An Impact of Macrophage Responses and Immune Deposition in Gut

“…Second, there is a limitation in the mouse model due to the very high dose of indomethacin compared to a more typical lower dose in patients. Likewise, only indomethacin, a short-acting drug with a high GI side effect, was tested due to its popular utilization in animal models [ 42 , 43 ], despite a variety of newer drugs in the clinical practice. Third, only the gene expression, but not the protein abundance, of FcgRs was explored.…”

“…Despite an availability of the selective COX-2 inhibitory NSAIDs with a lower GI side effect, the short-acting nonselective COX-1 and COX-2 inhibitory NSAIDs are still currently used in several situations [37][38][39]. Indomethacin, a potent NSAID with a high likelihood of a GI side effect, continues to be administered to patients [40,41] and is frequently employed in animal models [42,43]. Here, our study performed both in vitro and in vivo investigations to determine the impact of indomethacin, a representative NSAID, against lupus using FcgRIIb-/-asymptomatic lupus mice at 24 wks old.…”

COVID-19 and NSAIDS: A Narrative Review of Knowns and Unknowns

“…In cases of multiple organ failure, which has happened with SARS, MERS, and possibly COVID-19, the use of NSAIDs might more easily be associated with gastrointestinal damage. If gastrointestinal symptoms occur, this should be carefully investigated and treated [21].…”

The Expanding Role of the COX Inhibitor/Opioid Receptor Agonist Combination in the Management of Pain

“…dexketoprofen trometamin salt) as well as the co-administration of proton-pump inhibitors. Finally, NSAID-induced enteropathy, associated with chronic history of NSAID use, is increasingly recognised as an undesirable effect, although still frequently undiagnosed because of its nonspecific signs and symptoms [ 21 ]. Overall, increased risk for GI untoward effects is not equally reported across the NSAID class and should be also considered with aspirin co-administration [ 19 , 20 ].…”