NSAID-induced damage to the gastrointestinal tract: new opportunities for the prevention of gastro- and enteropathies

Abstract

Nonsteroidal anti-inflammatory drug is one of the most commonly prescribed drugs for the treatment of inflammatory and pain syndromes in the clinical practice of doctors of various specialties. The popularity of this pharmacological group is increasing due to over-the-counter dispensing condition, but at the same time, the significance of issues of likelihood, prevention and treatment of severe adverse drug reactions during intake that is controlled and uncontrolled by medical personnel is increasing. This review is devoted to the issue of non-steroidal anti-inflammatory drug-induced damage to the gastrointestinal tract and to the current possibilities to prevent and manage such damage. The drugs that can increase the production of prostaglandins and mucus in the digestive tract and have a general anti-inflammatory effect raise significant hopes. Rebamipide draws particular attention due to numerous pleiotropic effects, including stimulation of secretion of newly formed prostaglandins and glycoproteins in the mucous membranes, inhibition of synthesis of oxidative stress products, inflammatory cytokines and chemokines by intestinal epithelial cells. The authors considered the effectiveness of prophylactic use of rebamipide in comparison with other strategies for the use of drugs to prevent the development of stomach ulcers, duodenal ulcers and distal small bowel ulcers. They described the mechanisms of prophylactic action and its debatable aspects for proton pump inhibitors, H2-histamine receptor blockers, misoprostol. The clinical efficacy of rebamipide is illustrated by a clinical example. The absence of effects on cytochrome P450 enzyme activity, which minimizes the risks of drug interactions and changes in bioavailability, biotransformation and excretion of the drug itself during its course use is an additional advantage of rebamipide.