Short- And Long-Term Effects of Nsaids on the Gastrointestinal Mucosa: Complex Analysis of Benefits and Complications Prevention

Abstract

The aim: To analyse data from recent studies, dedicated to the use of non-steroidal anti-inflammatory drugs (NSAIDs); to evaluate the best clinical practice in the use of NSAIDs in order to prevent side effects (SEs) in different clinical scenarios; to optimise treatment of patients at risk of NSAIDs-related SEs. Materials and methods: A comprehensive bibliographic search was performed using the keywords “NSAIDs”, “NSAID gastropathy”, “NSAID enteropathy”, “complications of NSAID therapy”, “cardiovascular disease”, “cardiovascular risk” in the PubMed, Web of Science, Cochrane Library, Google Academy databases. Conclusions: NSAID-induced gastrointestinal lesions are а relevant problem of internal medicine, this is due to the fact that the pathogenic mechanisms of this process are still unclear. All the gastrointestinal tract (GIT) related risk factors(RFs) for gastro- and enterocolonopathies associated with the use of NSAIDs should be taken into consideration by physicians of all specialties. The examination and diagnostic of the GIT should be performed regularly to prevent complications. Uncontrolled, long-lasting, unprescribed NSAID usage should draw the attention of doctors, especially in patients with comorbid states.

Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review

“…Since PG have gastroprotective action by increasing blood flow to stomach mucosa and augmenting the synthesis of mucus that lines and protects the stomach wall from hydrochloric acid (HCL) induced damage which is considered as a primary agent that harms the stomach mucosal lining [60]. Acidinduced mucosal damage is categorized either by the partial loss of mucosa (erosion) or the full-thickness loss of mucosa with exposure to underlying submucosa (ulcer) (Figure 3) [51,52,67]. The diagnosis is made by visualization of erosion or ulceration via endoscopy [52,68].…”

“…Traditional NSAIDs inhibit COX-1, leading to the inhibition of prostaglandin E2(PGE2) synthesis [ 57 , 60 , 66 , 67 ]. Since PG have gastroprotective action by increasing blood flow to stomach mucosa and augmenting the synthesis of mucus that lines and protects the stomach wall from hydrochloric acid (HCL) induced damage which is considered as a primary agent that harms the stomach mucosal lining [ 60 ].…”

“…Selective COX-2 inhibitors are known to possess similar anti-inflammatory and analgesic properties as tNSAIDs [ 84 ]. COX-1 is expressed in naturally occurring cells throughout the body, while COX-2 is specific to cells involved in inflammation [ 67 ]. tNSAIDs block PG synthesis in both inflammatory and normal cells of the GIT, while COX-2 selective NSAIDs primarily inhibit PG synthesis involved in pain and inflammation, leaving PG synthesis in normal cells intact (Figure 4 ) [ 49 ].…”

“…NSAIDs can cause esophagitis by their direct irritating effect on the esophageal epithelium and can also reduce the motility of the lower esophageal sphincter and stomach, leading to gastroesophageal reflux and dyspepsia [ 52 ]. NSAIDs can irritate the gastric epithelium lining, resulting in gastritis, and increase the risk of erosion and ulcer formation by inhibiting mucus production by the stomach's goblet cells and decreasing the acid washout from the gastric epithelium [ 57 , 60 , 66 , 67 ]. Moreover, NSAIDs can decrease thromboxane synthesis, which leads to bleeding in the gastric epithelium [ 61 ].…”

Grape Pomace Polyphenols as a Source of Compounds for Management of Oxidative Stress and Inflammation—A Possible Alternative for Non-Steroidal Anti-Inflammatory Drugs?

“…They possess anti-inflammatory, antipyretic, and analgesic effects and therefore are prescribed for many diseases, especially chronic diseases like rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and chronic pain [ 22 , 23 , 24 ]. Unfortunately, the therapeutic effects can be associated with pulmonary, renal, gastrointestinal, cardiovascular, and hepatic adverse reactions that might lead to severe complications [ 25 , 26 , 27 , 28 ]. Thus, there is an urgent need in identifying novel antioxidant and anti-inflammatory agents, therapeutically potent and with minimal side effects that could be used instead of classical drugs or as add-on therapy, and GP could be a source of such kind of compounds.…”