美国胃肠病学会（AGA）有关开据 NSAIDs病患的建议

吲哚类抗抑郁药的领域有如高发消化道中风专家组合意订定推荐提议来加大不确定性据美国政府胃肠病研习召集的多学科专家组详述，吲哚类抗抑郁药给有高血压的症状提供了广阔的效用，但是保健政府部门在给治疗先为于据这镇静剂当年，须要仔细考虑它的有如不确定性。消化道病变是用到非类抗抑郁药的最常见的不良重排，之外上消化道和下消化道的中风。严重的消化道中风，如潜在的致命性并发症性肿胀，年死亡率为其他用户的1－4％。专家组的讨论结果“关于订定吲哚类抗抑郁药之外内层羟化酶－2发挥作用剂和类制剂的领域提议研讨的共识”发表在美国政府胃肠病研习出版社的9上半年的《临床胃肠病学与骨髓病学》杂志上。“吲哚类抗抑郁药是迄今为止领域最最常的制剂，而且最常的领域证实了它的功效和相对稳定性” 据霍普金斯大学格拉斯哥分校内科学副教授，论文的主要编者C. Mel Wilcox哈佛大学详述。“但是，只不过虽然充分认识了消化道中风，而没有认识到其心脏致命，美国政府胃肠病研习召集国民议会来降高于对领域该镇静剂的效用和消化道及肾脏危险性的不确定性，从而改进对该镇静剂的领域。”估计迄今为止每年耗损500亿类制剂片，其中美国政府大约6000万份本品先为于据了类制剂，并主要给老年治疗。这镇静剂对急、慢性疼痛和四肢肌肉瘙痒等之外有效。但是，吲哚类抗抑郁药的用到有如着严重的致命，之外消化道、肾脏和肾脏中风，甚至之外心绞痛和心肌梗死。“我们吃惊地看到吲哚类抗抑郁药的消化道中风和死亡已经从1992年先为于始下滑，我们显然这种状况归功于一下之外：小高于剂量用到吲哚类抗抑郁药；下滑了肠胃肠胃的流行；降高于了质子泵发挥作用剂的领域；以及市场销售对消化道更安全的吲哚类抗抑郁药的领域，如昔布镇静剂。” Wilcox哈佛大学说道。“但是，保健政府部门和治疗须要了解该镇静剂的之外不确定性来订定吲哚类抗抑郁药的最佳领域提议。专家组为保健政府部门订定了当他们在决定是否给治疗先为于吲哚类抗抑郁药时的以下建言：评价用药的高血压和治疗时有发生消化道和肾脏中风的潜在致命遗传物质，并和治疗讨论肾脏疾病的潜在致命遗传物质。对不确定性和效用来进行比对来衡量个体消化道和肾脏致命后，先为于据高于不确定性的制剂。消化道并发症时有发生致命大的症状须要领域消化道不确定性高于的吲哚类抗抑郁药，例如非功能性吲哚类抗抑郁药；肾脏事件时有发生不确定性大的症状须要给予内层氧酶－2发挥作用剂用药；有已知肾脏疾病或肾脏病不确定性的治疗须要给予小高于剂量类制剂。受限制所先为于吲哚类抗抑郁药的时间尺度和高于剂量，以及征询并建言治疗来进行吲哚类抗抑郁药的联合用药。在领域吲哚类抗抑郁药用药当年，先为处理肠胃肠胃的细菌感染，以致不降高于都将消化性肿胀的不确定性。针对消化道中风不确定性大的症状订定胃肠保护提议，如领域米索当年列衍生物或质子泵发挥作用剂。“吲哚类抗抑郁药的领域有如高于消化道中风在检验和用药上很重要，” Wilcox哈佛大学表述说道。“更好地理解高于消化道并发症时有发生的不确定性和物理性质是减少吲哚类抗抑郁药的用到致命所须要的。”在国民议会过后讨论的药物都是非类发挥作用瘙痒重排的制剂，因此在学术上被显然是吲哚类抗抑郁药。非功能性的吲哚类抗抑郁药，之外布洛芬、依托度酸和苯胺丁美酯，它们比其他吲哚类抗抑郁药，例如舒林酸、吲哚美辛、吡罗昔康和酯咯酸对消化道有着更高的稳定性。昔布镇静剂是功能性内层羟化酶－2抗病毒。在规格高于剂量下，扑热息痛不是吲哚类抗抑郁药。美国政府胃肠病研习专家组由胃肠病学、风湿病学、心脏病学和内科学医师合组，他们在小组讨论后，以当当年科研报告为基础订定了这个提议。美国政府胃肠病研习举办的“关于吲哚类抗抑郁药的领域的国民议会”由TAP制剂美国政府公司提供的一项无限教育信托基金资助。与会者的内政工作量公布包括在原稿内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.编辑：bluelove 编辑： Zhu