The Damage of Gastrointestinal Tract Mucosa Caused by Non-Steroidal Anti-Inflammatory Agents and Other Drugs

Nonsteroidal anti-inflammatory agents are drugs that are frequently linked to side effects; in the Czech Republic approximately 500 000–600 000persons use them for treatment and at least 300 patients a year die from complications caused by the treatment. NSAID-related gastropathy manifests itself in the appearance of gastric or duodenal mucosa alterations such as erosions and petechia (50%), ulcers (5–30%), aphthae,mucosal erythema, or in complications (1–2%), particularly in upper GIT bleeding and perforation. Clinical effects include dyspeptic syndromeor anaemia. There is, however, low correlation between subjective symptoms and the endoscopic picture. Recommended treatment consistsin the discontinuation or reduction of the use of NSAID, testing for and treating Helicobacter pylori, and the administration of proton-pumpinhibitors. NSAID-related enteropathy includes alterations in intestinal permeability, ulcers, strictures, bleeding, or perforation. The conditionmay manifest itself in occult bleeding and the development of anaemia, or in the loss of proteins and the appearance of hypalbuminemiea,diarrhoea, weight loss. Strictures may cause colicky abdominal pain or a subileus condition. Inflammatory alterations and occult bleeding arereduced by metronidazole. The therapy also employs sulfasalazine and probiotics. Due to these factors the indication for the use of non-steroidalanti-inflammatory drugs should always be carefully considered.

Keywords: peptic ulcer, non-steroidal anti-inflammatory drugs, NSAID, gastropathy, enteropathy, gastrointestinal tract