What is an NSAID? Nonsteroidal Anti-inflammatory drug. In this paper, the mechanism of action of NSAIDs and their critical gastrointestinal complications have been reviewed. This paper also provides. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most highly prescribed drugs to decrease NSAID-induced GI damage including use of.
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T39.395 Non-steroidal anti-inflammatory drug-associated gastropathy (disorder)
gasrropati These drugs are used to decrease pain and inflammation and are often taken by those diagnosed with osteoarthritis and rheumatoid arthritis or other musculoskeletal conditions. NSAID induced gastropathy can result in stomach or duodenal ulcers which may even lead to death. Though these rates are high, most individuals do not know the risk of these medications and continue to take them. Also, this induced gastropathy goes on asymptomatically until it is too late and has caused further damage of the gastrointestinal tract.
Prevention and Treatment of NSAID Gastropathy.
Proton pump inhibitor PPI omeprazole reduces gastric ulcer and prevents duodenal ulcer . Though PPIs can help with gastric irritation, it is also found that they can induce risk of osteoporosis which often cause hip fractures in elderly patients as well as increase cardiovascular risk due to low serum magnesium levels in the blood.
H2 receptor antagonists are effective in preventing duodenal ulcer but not gastric ulcer. An early finding of anemia may warrant more extensive diagnostic testing such as an endoscopy or radiography in determination gastropatj NSAID gastropathy.
Hematocrit and nsakd levels may also provide information about the extent of bleeding from perforation or hemorrhage. See Tamblyn et al study on high gastropathy diagnostic rates by physicians .
Radiography with barium can also detect and diagnose peptic ulcers but is less common than endoscopy. NSAIDs inhibit the enzyme cyclooxygenase which is a necessary enzyme for the synthesis of prostaglandins from arachidonic acid. While inhibition of COX allows NSAIDs to have their anti-inflammatory and analgesic properties by blocking proinflammatory prostaglandins, it also blocks prostaglandins that protect the gastrointestinal gstropati.
Prostaglandins in the gastric system gastroapti maintain gastric blood flow, increase bicarbonate production, and increase mucus that serves as a protective barrier against bacteria colonization and mechanical injury.
Decreased blood flow and decreased mucosa decrease the healing ability and leave the stomach more exposed to injury from pepsin and gastric acid.
The function of cyclooxygenase in this process led to the establishment of two COX isoforms: COX-1 is found throughout all tissues of the body whereas COX-2 is in the area of inflammation such as in an area of osteoarthritis contributing to the inflammation.
COX-2 inhibitors are associated with fewer upper GI side effects, however, they are not as symptom free as hoped and still place people at risk of gastroduodenal mucosa injury. These medications are discussed below in the medical management section.
A potential complication of ulcers left untreated is that the ulcer can perforate through the stomach mucosa and cause infection to spread or the ulcer can erode stomach arteries creating a life-threatening bleed. Therefore, it is essential that health care professionals assess each patient’s risk factors and recommend either discontinued use of an NSAID or inclusion an accompanying cytoprotectant agent in those patients considered high risk.
Other treatment options include misoprostol which is a synthetic prostaglandin designed to replace those loss by NSAIDs. However, misoprotol has a lot of side effects that have proved difficult such as abdominal pain, nausea, and diarrhea . PTs must be aware of risk factors, clinical signs and systems and be aware the patient may be asymptomatic but still have NSAID induced gastropathyand they must take a detailed patient history including medication questions concerning multiple NSAIDs, prescription drugs combined with NSAIDs, and changes to medications.
Any patient who presents with new onset of back or shoulder pain, who takes NSAIDs, and who presents with signs and symptoms of a peptic ulcer must be referred to the MD.
Peptic ulcers are typically caused by H. Crohn’s Disease is a type of inflammatory bowel disease which causes the gastrointestinal tract to be gastropatj inflammed. Common symptoms of this disease include abdominal gaxtropati, diarrhea, blood in the stool and vomiting and can even cause rectal or gastrointestinal bleeding, loss of appetite and liver inflammation.
The most common symptom is heartburn but those with GERD can also have a dry cough, asthma-like symptoms, and trouble swallowing.
The relationship between upper gastrointestinal hemorrhage and drug use: COX-2 inhibitors are an option but they are more expensive. The content on or accessible through Physiopedia is for informational purposes only.
Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Toggle navigation p Physiopedia. Contents Editors Categories Share Cite. Retrieved from ” https: Bellarmine Student Project Medical Pharmacology.