ABSTRACT

INTRODUCTION. More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. Adverse drug reactions from the gastrointestinal tract induced by NSAIDs are the most common and worldwide up to 25% of NSAIDs users develop pepticulcer and 2-4% present with the complications of perfora-tion or bleeding.

МАТЕРИАЛЫ И МЕТОДЫ. A review of the literature on this topic was conducted for the period from 1994 to 2025 conducted in the following databases: PubMed, Research Gate, Elsevier using the keyword «NSAID gastropathy».

DISCUSSION. Guide for managing patients with NSAID gastropathy: Step 1 – withdrawal NSAIDs or replace them with a "selective" NSAID or treatment without withdrawal NSAIDs. Step 2 - select a PPI and dose, a combination of a PPI with a bismuth drug or rebamipide for 4-8 weeks. Step 3 – test and treat Helicobacter pylori infection. Step 4 - Preventive administration of a PPI with an NSAID, adding rebamipide in courses of up to 8 weeks. Preventive measures aimed at preventing NSAID-gastropathy should include: 1 - collect anamnes and identify high-risk patients; 2 - test and treat Helicobacter pylori infection; 3 – in high-risk patients, preventive administration of a PPI with an NSAID, adding rebamipide in courses of up to 8 weeks.

CONCLUSION. NSAID-gastropathy is a serious problem of medicine. The growing number of patients using NSAIDs increases the number of adverse drug reactions, which in some cases lead to death. Therefore, adequate prevention at the stage preceding the long-term administration of NSAIDs, as well as timely diagnosis and treatment of NSAID-gastropathy will help reduce the number of patients with erosive and ulcerative lesions of the gastrointestinal tract and prevent fatal complications.

KEYWORDS: NSAID-gastropathy, gastric erosions, gastric ulcers, nonsteroidal anti-inflammatory drugs

For citation: Tryapyshko A.A., Dekhnich N.N. NSAID-Gastropathy: Patient Management Guide. A Review. Comorbidity Neurology. 2025; 2 (1): 26-32. https://doi.org/10.62505/3034-185x-2025-2-1-26-32

*For correspondence: Andrey A. Tryapyshko, Assistant of the Department of faculty therapy, Smolensk State Medical University, Smolensk, Russia, e-mail: dron9412@yandex.ru

REFERENCES

1.Singh G., Triadafilopoulos G. Epidemiology of NSAID induced gastrointestinal complications. Journal of Rheumatology Supplement. 1999; 56: 18–24.

2.Lanza F.L., Chan F.K.L., Quigley E.M.M., et al. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009; 104 (3): 728-738. https://doi:10.1038/AJG.2009.115

3.Lim Y.J., Lee J.S., Ku Y.S., Hahm K.B. Rescue strategies against non-steroidal anti-inflammatory drug-induced gastroduodenal damage. J Gastroenterol Hepatol. 2009; 24 (7): 1169-1178. https://doi:10.1111/J.1440-1746.2009.05929.X

4.Комаров Ф.И., Рапопорт С.И. Руководство по гастроэнтерологии. М: ООО «Медицинское информационное агентство»; 2010. 864 с. (In Russ.)]

5.Ivashkin V.T., Sheptulin A.A., Mayev I.V., et. al. Russian gastroenterological association clinical guidelines on diagnostics and treatment of NSAIDs-associated erosive and ulcerative lesions of the stomach and duodenum. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2014; 24 (6): 89-94. (In Russ.)

6.Cheng H., Huang H., Guo Z., et al. Role of prostaglandin E2 in tissue repair and regeneration. Theranostics. 2021; 11 (18): 8836-8854. https://doi:10.7150/THNO.63396

7.Bordin D.S., Livzan M.A., Gaus O.V., et al. Drug-Associated Gastropathy: Diagnostic Criteria. Diagnostics (Basel). 2023; 13 (13). https://doi:10.3390/DIAGNOSTICS13132220

8.Santucci L., Fiorucci S., Giansanti M., et al. Pentoxifylline prevents indomethacin induced acute gastric mucosal damage in rats: role of tumour necrosis factor alpha. Gut. 1994; 35 (7): 909-915. https://doi:10.1136/GUT.35.7.909

9.Fiorucci S., Antonelli E., Morelli A. Mechanism of non-steroidal anti-inflammatory drug-gastropathy. Dig Liver Dis. 2001; 33. Suppl 2. https://doi:10.1016/S1590-8658(01)80157-2

10.Kamada T., Satoh K., Itoh T., et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2020. J Gastroenterol. 2021; 56 (4): 303-322. https://doi:10.1007/S00535-021-01769-0

11.Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr. 2017; 40 (3): 91-93. https://doi:10.18773/AUSTPRESCR.2017.037

12.Vergara M., Catalán M., Gisbert J.P., Calvet X. Meta-analysis: role of Helicobacter pylori eradication in the prevention of peptic ulcer in NSAID users. Aliment Pharmacol Ther. 2005; 21 (12): 1411-1418. https://doi:10.1111/J.1365-2036.2005.02444.X

13.Bhatt D.L., Scheiman J., Abraham N.S., et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2008; 118 (18): 1894-1909. https://doi:10.1161/CIRCULATIONAHA.108.191087

14.Marcén B., Sostres C., Lanas A. NSAID and gastrointestinal risk. Aten Primaria. 2016; 48 (2): 73-76. https://doi:10.1016/J.APRIM.2015.04.008

15.Hernández-Díaz S., García Rodríguez L.A. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med. 2000; 160 (14): 2093-2099. https://doi:10.1001/ARCHINTE.160.14.2093

16.Gillen D., McColl K.E.L. Problems associated with the clinical use of proton pump inhibitors. Pharmacol Toxicol. 2001; 89 (6): 281-286. https://doi:10.1034/J.1600-0773.2001.D01-161.X

17.Miyake K.S.C. Lanza score. Stomach and Intestine. 2012; 47: 866 p.

18.Yang M., He M., Zhao M., et al. Proton pump inhibitors for preventing non-steroidal anti-inflammatory drug induced gastrointestinal toxicity: a systematic review. Curr Med Res Opin. 2017; 33 (6): 973-980. https://doi:10.1080/03007995.2017.1281110

19.McCabe M.E., Dilly C.K. New Causes for the Old Problem of Bile Reflux Gastritis. Clin Gastroenterol Hepatol. 2018; 16 (9): 1389-1392. https://doi:10.1016/J.CGH.2018.02.034

20. Galiev S.Z., Amirov N.B. Duodenogastric reflux as a cause of reflux-gastritis. Bulletin of Contemporary Clinical Medicine. 2015;8 (2): 50-61 (In Russ.)

21.Zhang W.T., Wang M.R., Hua G.D., et al. Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis. Front Pharmacol. 2021; 12. https://doi:10.3389/FPHAR.2021.730681

22.Goldstein J.L., Johanson J.F., Suchower L.J., Brown K.A. Healing of gastric ulcers with esomeprazole versus ranitidine in patients who continued to receive NSAID therapy: a randomized trial. Am J Gastroenterol. 2005; 100 (12): 2650-2657. https://doi:10.1111/J.1572-0241.2005.00243.X

23.Chan F.K.L., To K.F., Wu J.C.Y., et al. Eradication of Helicobacter pylori and risk of peptic ulcers in patients starting long-term treatment with non-steroidal anti-inflammatory drugs: A randomised trial. Lancet. 2002; 359 (9300): 9-13. https://doi:10.1016/S0140-6736(02)07272-0

24.Chan F.K.L., Sung J.J.Y., Chung S.C.S., et al. Randomised trial of eradication of Helicobacter pylori before nonsteroidal anti-inflammatory drug therapy to prevent peptic ulcers. Lancet. 1997; 350 (9083): 975-979. https://doi:10.1016/S0140-6736(97)04523-6

ADDITIONAL INFORMATION

Andrey A. Tryapyshko, Assistant of the Department of faculty therapy, Smolensk State Medical University, Smolensk, Russia. E-mail: dron9412@yandex.ru. ORCID: https://orcid.org/0000-0003-4652-8161м

Natalia N. Dekhnich, Dr. Sci. (Med.), Professor of the Department of faculty therapy, Smolensk State Medical University, Smolensk, Russia. E-mail: n.dekhnich@mail.ru. ORCID: https://orcid.org/0000-0002-6144-3919

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Tryapyshko A.A. – conceptualization, methodology, formal analysis, writing – original draft, writing – review, editing; Dekhnich N.N. – conceptualization, methodology,  writing – review, editing, data curation.

Funding. This study was not supported by any external sources of funding.

Disclosure. The authors declare that they have no competing interests.

The content is available under the Creative Commons Attribution 4.0 License.

©2025. Andrey A. Tryapyshko, Natalia N. Dekhnich