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Vol. 31. Issue S4.
Jornada de Actualización en Gastroenterología Aplicada
Pages 35-41 (October 2008)
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Vol. 31. Issue S4.
Jornada de Actualización en Gastroenterología Aplicada
Pages 35-41 (October 2008)
Jornada de actualización en gastroenterología aplicada
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Actualización en enfermedad gastrointestinal relacionada con antiinflamatorios no esteroideos
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Ángel Lanas
Corresponding author
angel.lanas@gmail.com

Correspondencia: Servicio de Aparato Digestivo. Hospital Clínico Universitario Lozano Blesa. San Juan Bosco, 15. 50009 Zaragoza. España.
Servicio de Aparato Digestivo. Hospital Clínico Universitario Lozano Blesa. CIBEREHD. IACS. Universidad de Zaragoza. Zaragoza. España
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Resumen

Los estudios más recientes presentados en el congreso americano de 2008 en relación con el uso de antiinflamatorios no esteroideos (AINE) o el ácido acetilsalicílico (AAS) y el tracto gastrointestinal han señalado un creciente interés de los investigadores por los efectos secundarios que estos fármacos inducen en el tracto gastrointestinal inferior. Así se ha señalado que existe una creciente incidencia temporal de estos eventos que casi alcanza la señalada para los del tracto gastrointestinal superior, un efecto que parece extensible a los asociados a AINE y AAS. Otro aspecto de interés se ha centrado en la deficiente cobertura gastroprotectora que reciben las personas con factores de riesgo tratadas con AINE o AAS. Diversos estudios han estudiado diversos aspectos relacionados y han señalado que más del 50% de estos pacientes no reciben terapia apropiada. El análisis personal indica que la edad sería el principal factor de éste déficit. El conocimiento de los factores de riesgo y las potenciales medidas de prevención entre los médicos que prescriben AINE parece adecuado al término de la residencia, pero no parece que después se ponga en práctica. La solución a este problema no parece fácil, ya que ni aun disponiendo de recordatorios y de fármacos gratuitos se alcanzan los objetivos deseables. Una manera de cubrir este déficit podría venir de los preparados comerciales combinados (AINE + inhibidores de la bomba de protones) que en un estudio se ha demostrado conllevan menos daño gastroduodenal, con lo que se obviaría el problema de la necesidad de prescribir ambos y el incumplimiento de los pacientes.

Palabras clave:
AINE
Ácido acetilsalicílico
Inhibidores de la bomba de protones
Coxib
Hemorragia gastrointestinal
trointestinal
Abstract

The most recent studies presented at Digestive Disease Week 2008 on non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin have revealed the growing interest of investigators in the adverse effects of these drugs in the lower gastrointestinal (GI) tract. Some studies have shown that there is an increasing time trend of lower GI events and a decreasing time trend of upper GI events, and that the number of events associated with NSAIDs and/or aspirin located in the lower GI tract is approaching that of events located in the upper GI tract.

Another area of growing research interest is the lack of appropriate gastroprotective therapy in patients with risk factors who received NSAIDS or aspirin. Several studies have investigated diverse aspects related to this area and most indicate that at least 50% of at-risk patients treated with NSAIDs (or aspirin) do not receive appropriate gastroprotective therapy.A personal analysis of the data suggests that the risk factor most frequently associated with lack of gastroprotection is age.

Knowledge of risk factors and potential therapeutic measures are appropriate among senior residents, but is not subsequently translated into clinical practice.There is no easy solution to this problem since, even within the best conditions of a mega-trial (MEDAL trial) with free available gastroprotection and intervention during the trial, investigators could not reach reasonable gastroprotection rates in at-risk patients.One potential solution may come from combination pills (e.g. NSAID+proton pump inhibitor). One study showed that this combination was associated with fewer gastroduodenal lesions and could avoid the need to prescribe a gastroprotective agent and poor compliance.

Key words:
NSAIDs
aspirin
proton pump inhibitors
coxibs
gastrointestinal bleeding
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Bibliografía
[1.]
A. Lanas, J. Panés, J.M. Pique.
Clinical implications of COX-1 and/or COX-2 inhibition for the distal gastrointestinal tract.
Curr Pharm Des, 9 (2003), pp. 2253-2266
[2.]
A. Lanas, L.A. Garcia-Rodriguez, M. Ponce, L. Rodrigo, L. Bujanda, J.P. Gisbert, et al.
Clinical impact and time trends of upper and lower gastrointestinal complications.
Gastroenterology, 134 (2008), pp. 113
[3.]
S. Loperfido, V. Baldo, E. Piovesana, L. Bellina, K. Rossi, M. Groppo, et al.
Decline of incidence and mortality of peptic ulcer bleeding between 1983-85 and 2002-04: A population-based study in the Treviso Area (North-East Italy).
Gastroenterology, 134 (2008), pp. 435
[4.]
J.Y. Lau, J.J. Sung, D. Metz, C.W. Howden.
Systematic review of the epidemiology of complicated peptic ulcer: incidence, recurrence, risk factors and mortality.
Gastroenterology, 134 (2008), pp. 187
[5.]
B. Sondergaard, C. Reimer, P. Bytzer.
Causes of uncomplicated peptic ulcer. a report of 274 patients from a single Danish center.
Gastroenterology, 134 (2008), pp. T1067
[6.]
R.E. Coleman.
Risks and benefits of bisphosphonates.
Br J Cancer, 98 (2008), pp. 1736-1740
[7.]
M. Kusunoki, K. Miyake, M. Umezawa, T. Shindo, N. Ueki, T. Hiratsuka, et al.
Bisphosphonate increases risk of peptic ulcer in rheumatoid arthritis patients on long-term non-steroidal anti-inflammatory drug therapy.
Gastroenterology, 134 (2008), pp. T1675
[8.]
F.J. De Abajo, L.A. García-Rodriguez.
Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents.
Arch Gen Psychiatry, 65 (2008), pp. 795-803
[9.]
L.E. Targownik, C.J. Metge, S. Leung.
Serotonin selective reuptake inhibitors (SSRIs) are not associated with an increased risk of upper gastrointestinal events in users of non-steroidal anti-inflammatory drugs (NSAIDs).
Gastroenterology, 134 (2008), pp. W1926
[10.]
A. Lanas, R. Hunt.
Prevention of anti-inflammatory drug-induced gastrointestinal damage: benefits and risks of therapeutic strategies.
Ann Med, 38 (2006), pp. 415-428
[11.]
M.W. Van der Linden, S. Van der Bij, E.J. Kuipers, R.M. Herings.
The balance between severe cardiovascular and gastrointestinal events among users of selective and non selective non steroidal anti-inflammatory drugs.
Gastroenterology, 134 (2008), pp. W1059
[12.]
A. Lanas, L.A. García-Rodríguez, M.T. Arroyo, F. Gomollón, F. Feu, A. González-Pérez, et al.
Risk of upper gastrointestinal ulcer bleeding associated with selective cyclo-oxygenase-2 inhibitors, traditional non-aspirin non-steroidal anti-inflammatory drugs, aspirin and combinations.
Gut, 55 (2006), pp. 1731-1738
[13.]
C.P. Cannon, S.P. Curtis, G.A. FitzGerald, H. Krum, A. Kaur, J.A. Bolognese, et al.
Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison.
Lancet, 368 (2006), pp. 1771-1781
[14.]
M.M.W. Van der Linden, E.J. Kuipers, M.P. Sukel, R.M. Herings, S. Gaugris.
Hospitalizations for gastrointestinal events among users of COX-2 inhibitors compared with traditional non-steroidal anti-inflammatory drugs with proton-pump inhibitors.
Gastroenterology, 134 (2008), pp. W1060
[15.]
F.K. Chan, L.C. Hung, B.Y. Suen, J.C. Wu, K.C. Lee, V.K. Leung, et al.
Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis.
N Engl J Med, 347 (2002), pp. 2104-2110
[16.]
L. Laine, S.P. Curtis, B. Cryer, A. Kaur, C.P. Cannon.
Assessment of upper gastrointestinal safety of etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison.
[17.]
K. Gudis, S. Fujimori, Y. Yamada, Y. Takahashi, T. Seo, A. Ehara, et al.
Small intestinal mucosal breaks with short-term administration of non-steroidal anti-inflammatory drugs.
Gastroenterology, 134 (2008), pp. T1656
[18.]
Y. Hashimoto, Y. Kuroki, Y. Endo, N. Maruoka, O. Ogawa, H. Yoshikumi, et al.
The influence of NSAIDs use on diagnosis of obscure gi bleeding at double balloon endoscopy.
Gastroenterology, 134 (2008), pp. T1638
[19.]
G. Thiefin, F. René-Marc, T. Schaeverbecke, C. Soufflet, P. Barthelemy.
Characteristics and impact of upper GI symptoms in patients treated with NSAIDs: Results of a cross sectional epidemiological study in primary care.
Gastroenterology, 134 (2008), pp. W1921
[20.]
A. Lanas, L.A. García-Rodríguez, M.T. Arroyo, L. Bujanda, F. Gomollón, M. Forné, et al.
Effect of antisecretory drugs and nitrates on the risk of ulcer bleeding associated with nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants.
Am J Gastroenterol, 102 (2007), pp. 507-515
[21.]
L. Laine, L. Connors, M. Griffin, S.P. Curtis, C.P. Cannon.
Physicians fail to provide protective co-therapy for high GI risk patients taking NSAIDs –Even with direct interactive communication and free PPI: Results of a prospective outcomes trial.
Gastroenterology, 134 (2008), pp. 117
[22.]
G. Thiefin, P.H. Delaage, P. Barthelemy.
Gastroprotection in patients at risk of gastrointestinal NSAID complications : Results of a general practitioner based survey in France.
Gastroenterology, 134 (2008), pp. W1925
[23.]
G.A. Cote, F. Siqueira, J.P. Rice, C.W. Howden.
Knowledge of risk factors for NSAID-related upper GI complications and role of gastroprotection among senior resident physicians.
Gastroenterology, 134 (2008), pp. W1065
[24.]
G.P. Gaspard, D.L. Castillo, N.S. Abraham.
Clinical knowledge gaps, formative training and safer NSAID prescription.
Gastroenterology, 134 (2008), pp. W1062
[25.]
J.L. Goldstein, M.B. Sostek, J.G. Fort, D.S. Riff, Y. Zhang, J.R. Plachetka.
A single tablet multilayer formulation of enteric-coated naproxen coupled with non-enteric-coated omeprazole is associated with a significantly reduced incidence of gastric ulcers vs. enteric-coated naproxen: a prospective, randomized, doubleblind study.
Gastroenterology, 134 (2008), pp. 116
[26.]
F.K.L. Chan, B.Y. Suen, V.W. Wong, J. Wu, J.J. Sung.
Combination of a cyclooxygenase (COX)-2 selective NSAID and a proton pump inhibitor for prevention of gastroduodenal ulcers in very high risk patients: A one-year, double-blind, randomized trial.
Gastroenterology, 134 (2008), pp. 114
[27.]
S. Fujimori, T. Seo, K. Gudis, A. Tatsuguchi, A. Ehara, Ti. Kobayash, et al.
Prevention of NSAID-induced small intestinal injury by prostaglandin: a pilot randomized controlled trial.
Gastroenterology, 134 (2008), pp. T1303
[28.]
J.F. Bretagne, B. Bernard Nalet, G. Gilles Lesur, B. Bruno Bour, P. Philippe Barthelemy, C. Soufflet.
Characteristics of GI bleeding occurring in patients on antiplatelet therapy. Results of a prospective cohort of patients recruited in 61 French hospitals.
Gastroenterology, 134 (2008), pp. W1914
[29.]
E. Smecuol, M.I. Pinto Sanchez, A. Suarez, J.E. Argonz, E. Sugai, H. Vazquez, et al.
Low dose aspirin affects the small bowel mucosa. Results of a pilot study using a multidimensional assessment.
Gastroenterology, 134 (2008), pp. W1927
[30.]
T. Shibuya, T. Ohkusa, T. Yokoyama, K. Beppu, N. Sakamoto, A. Kurosawa, et al.
Colonic mucosal disorder associated with low-dose aspirin: a case-control study.
Gastroenterology, 134 (2008), pp. W1583
[31.]
A.S. Taha, W.J. Angerson, R. Prasad, C. McCloskey, D.K. Gilmour.
Early mortality after upper gastrointestinal bleeding and the use of low-dose aspirin and anti-thrombotic therapy and non-steroidal anti-inflammatory drugs.
Gastroenterology, 134 (2008), pp. W1916
[32.]
A.S. Taha, W.J. Angerson, R. Prasad, C. McCloskey, D.K. Gilmour.
Thirty-day mortality after peptic ulcer perforation and the use of low-dose aspirin and non-steroidal anti inflammatory drugs.
Gastroenterology, 134 (2008), pp. W1923
[33.]
U. Basavaraju, J.M. Thomson, D.L. Armour, N.A. Mowat, A. Fraser.
Influence of aspirin and non-steroidal anti-inflammatory drug (NSAID) use on the outcomes of bleeding peptic ulcers: 10 year experience of a specialised bleeding unit.
Gastroenterology, 134 (2008), pp. W1902
[34.]
J.R. Boike, B. Markle, D. Meyer, R. Kao, J.A. Rosenberg, A.C. Stein, et al.
Does concomitant use of acetaminophen potentiate the gastroduodenal mucosal injury of aspirin: a prospective, randomized, pilot study.
Gastroenterology, 134 (2008), pp. W1918
[35.]
B. Cukor, B.L. Cryer.
The risk of re-bleeding after an index GI bleed in patients on anticoagulation.
Gastroenterology, 134 (2008), pp. T1541
[36.]
C. Kodaira, T. Furuta, M. Sugimoto, M. Yamade, M. Nishino, M. Ikuma, et al.
Protective effect of nitrates on the risk of ulcer bleedings induced by aspirin in Japan.
Gastroenterology, 134 (2008), pp. W1061
[37.]
G. Thiefin, G. Montalescot, F. Woimant, P. Barthelemy, C. Soufflet.
Prevalence and clinical impact of upper gastrointestinal symptoms in patients treated with low-dose aspirin.
Gastroenterology, 134 (2008), pp. W1924
[38.]
L.E. Targownik, C.J. Metge, S. Leung.
Gastroprotective strategies are underutilized in high-risk patients using cardioprotective doses of aspirin.
Gastroenterology, 134 (2008), pp. W1932
[39.]
G. Thiefin, G. Montalescot, F. Woimant, C. Soufflet, P. Barthelemy.
Epidemiological characteristics of low-dose aspirin treatment and gastroprotection in France: Results of a nation-wide postal survey.
Gastroenterology, 134 (2008), pp. W1922
[40.]
G. Thiefin, F. Woimant, G. Montalescot, P. Barthelemy, C. Soufflet.
Modalities of low-dose aspirin treatment and gastroprotective strategies in general and specialty practice in France.
Gastroenterology, 134 (2008), pp. W1930
[41.]
P.J. Ramsey, P. Richardson, N.S. Abraham.
Complex antithrombotic therapy prescription: prevalence and provider recognition of gastrointestinal risks.
Gastroenterology, 134 (2008), pp. T1041
[42.]
A.L. Yang, S. Vadhavkar, A.A. Ahmed, R.S. Cheung, G. Triadafilopoulos, B. Omary, et al.
Nonsteroidal anti-inflammatory drugrelated acute liver failure: a rare but serious adverse effect.
Gastroenterology, 134 (2008), pp. T1785
[43.]
M.V. Grau, R. Sandler, J.A. Baron.
Effect of NSAID use after randomized aspirin treatment on the risk of colorectal adenomas.
Gastroenterology, 134 (2008), pp. 991
[44.]
B.J. Elmunzer, A.K. Waljee, G.H. Elta, J. Taylor, S.M.A. Fehmi, P.D. Higgins.
A meta-analysis of NSAIDs in the prevention of post-ERCP pancreatitis.
Gastroenterology, 134 (2008), pp. W1625
Copyright © 2008. Elsevier España S.L.. Todos los derechos reservados
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