Gastroenterologìa (Oct 2020)
Nonsteroidal anti-inflammatory drugs: a modern understanding of the mechanisms of damage to the digestive tract, the shortcomings of pathogenetic drugs and prospects for biological therapy of NSAID-induced esophagogastroenterocolonopathy
Abstract
Background. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used daily by more than 30 million people, and their arsenal includes more than 80 drugs and about 1,000 dosage forms based on them. They are widely used in many areas of medicine and are one of the most clinically significant groups of drugs. However, the use of NSAIDs can often cause side effects, the most common of which are damage to the gastrointestinal tract. Objective: to characterize the current understanding of the mechanisms of damage to the digestive tract by nonsteroidal anti-inflammatory drugs, to assess the shortcomings of existing pathogenetic drugs and prospects for biological therapy of NSAID-induced esophagogastroenterocolonopathy with cryopreserved human placental extract. Materials and methods. The analysis was performed of the works published in 2010–2020, which covered information on the epidemiology, pathogenesis, diagnosis and treatment of lesions of the esophagus and gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs, as well as the biological properties of cryopreserved human placental extract as biological therapy. Results. Treatment of NSAID-induced esophagogastroenterocolonopathy is usually aimed at acid-suppressive therapy (proton pump inhibitors, H2-histamine blockers, etc.), the use of gastrocytoprotectors (de-nol, sucralfate, etc.) and drugs that restore the content of prostaglandins in the mucous membrane (misoprostol, rebamipide, etc.). However, all these groups of drugs do not sufficiently satisfy clinicians, as they are aimed primarily at treating NSAID gastropathy and have their own side effects. A new promising area for improving the safety of NSAIDs today is the use of biological therapies, the sources of which are microorganisms, organs and tissues of plant or animal origin, cells or fluids (including blood and plasma) of human or animal origin and biotechnological cell structures. Conclusions. The use of nonsteroidal anti-inflammatory drugs is significantly limited by their side effects, the most common of which are disorders of the gastrointestinal tract. Cryopreserved human placental extract is a promising biological therapy for ulcerogenic lesions of the gastrointestinal tract induced by nonsteroidal anti-inflammatory drugs.
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