E.A. Dikareva, E.V. Makarenko, S.I. Pimanov
The estimation of the risk of the development of gastropathy induced by the intake of nonsteroid anti-inflammatory drugs, based on international consensus documents
Educational Establishment «Vitebsk State Order of Peoples’ Friendship Medical University», Vitebsk, Republic of Belarus
Objectives. To evaluate the feasibility of predicting the risk of the development of erosive and ulcerative lesions of the mucous membrane (MM) of the gastroduodenal zone induced by the intake of nonsteroid anti-inflammatory drugs (NSAIDs) in patients with rheumatoid arthritis (RA).
Material and methods. 203 patients (160 women and 43 men) with RA were included in the study aimed at the assessment of the risk of the development of gastropathy induced by the intake of NSAIDs (NSAID-gastropathy), based on international recommendations. Patients did not take proton pump inhibitors (PPI) for the prevention of NSAID-gastropathy. In order to determine the presence of NSAID-gastropathy all patients underwent esophagogastroduodenoscopy. The assessment of gastrointestinal risk factors for the development of NSAID-induced lesions of the MM of the gastroduodenal zone was made on the basis of the international documents: Recommendations of the 1st International Working Group on the study of gastrointestinal and cardiovascular effects of NSAIDs and antiplatelet agents; Recommendations of the American College of Gastroenterology for the prevention of NSAID-induced ulcer complications.
Results. 62 patients (30,5%) out of 203 examined persons who were not taking PPIs developed erosive and ulcerative damages of the MM of the gastroduodenal zone, induced by the intake of NSAIDs.
The accuracy of evaluating the risk of NSAID-gastropathy development in patients with RA, long-term NSAID users, based on the recommendations of the 1st International Working Group on the study of gastrointestinal and cardiovascular effects of NSAIDs and antiplatelet agents made up 57,6%, sensitivity – 59,7% and specificity – 56,7%.
The accuracy of the method of prognosticating the development of erosive and ulcerative lesions of the MM of the gastroduodenal zone was 56,2%, sensitivity – 66,1% and specificity – 51,8% in accordance with the provisions set forth in the Guidelines of the American College of Gastroenterology for the prevention of ulcer complications associated with taking NSAIDs.
Conclusions. The conducted study has shown that in assessing the prognostic significance of risk factors for NSAID-gastropathy development based on the international recommendations the accuracy of this pathology detection turned out to be inadequate.
Key words: nonsteroid anti-inflammatory drugs, international documents.
1. Karateev AE. NPVP-assotsiirovannaia patologiia verkhnikh otdelov ZhKT: sovremennye aspekty problemy [NPVP-assotsiirovannaya pathology of the top departments of a gastrointestinal tract: modern aspects of a problem] [Elektronnyi resurs]. Medi.ru. Podrobno o lekarstvakh [sait]. Rezhim dostupa: http://medi.ru/doc/g421512.htm. Data dostupa: 22.07.2015.
2. Lanza FL, Chan FK, Quigley EM. Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009 Mar;104(3):728-38.
3. Laine L. Approaches to nonsteroidal anti-inflammatory drig use in the high-risk patient. Gastroenterology. 2001 Feb;120(3):594-606.
4. Lanza FL. A guideline for the treatment and prevention of NSAID-induced ulcers. Members of the Ad Hoc Committee on Practice Parameters of the American College of Gastroenterology. Am J Gastroenterol. 1998 Nov;93(11):2037-46.
5. Gabriel SE, Jaakkimainen L, Bombardier C. Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis. Ann Intern Med. 1991 Nov;115(10):787-96.
6. Lewis SC, Langman MJ, Laporte JR, Matthews JN, Rawlins MD, Wiholm BE. Dose-response relationships between individual nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) and serious upper gastrointestinal bleeding: a meta-analysis based on individual patient data. Br J Clin Pharmacol. 2002 Sep;54(3):320-6.
7. Hernández-Díaz S, Rodríguez LA. Association between nonsteroidal anti-inflammatory drugs and upper gastrointestinal tract bleeding / perforation: an overview of epidemiological studies published in the 1990s. Arch Intern Med. 2000 Jul;160(14):2093-9.
8. Bhatt DL, Scheiman J, Abraham NS, Antman EM, Chan FK, Furberg CD, Johnson DA, Mahaffey KW, Quigley EM. 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 Oct;118(18):1894-909.
9. Chan FK, Abraham NS, Scheiman JM, Laine L. Management of patients on nonsteroidal anti-inflammatory drugs: a clinical practice recommendation from the First International Working Party on Gastrointestinal and Cardiovascular Effects of Nonsteroidal Anti-inflammatory Drugs and Anti-platelet Agents. Am J Gastroenterol. 2008 Nov;103(11):2908-18.
10. Chan FK, Graham DY. Review article: prevention of non-steroidal anti-inflammatory drug gastrointestinal complications-review and recommendations based on risk assessment. Aliment Pharmacol Ther. 2004 May;19(10):1051-61.
11. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315-24.
12. Fries JF, Murtagh KN, Bennett M, Zatarain E, Lingala B, Bruce B. The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis. Arthritis Rheum. 2004 Aug;50(8):2433-40.
13. Lanas A, García-Rodríguez LA, Polo-Tomás M, Ponce M, Alonso-Abreu I, Perez-Aisa MA, Perez-Gisbert J, Bujanda L, Castro M, Muñoz M, Rodrigo L,Calvet X, Del-Pino D, Garcia S. Time trends and impact of upper and lower gastrointestinal bleeding and perforation in clinical practice. Am J Gastroenterol. 2009 Jul;104(7):1633-41.
14. Karateev AE. NPVP-gastropatiia: dinamika za 12 let [NPVP-gastropathy: dynamics in 12 years]. Nauch.-praktich. revmatologiia. 2011;(3):20–4.
15. Pimanov SI, Makarenko EV, Dikareva EA. Sobliudenie skhemy terapii ingibitorami protonnogo nasosa pri postoiannom prieme nesteroidnykh protivovospalitel'nykh sredstv [Keeping of the scheme of therapy by inhibitors of the proton pump at continuous reception of nonsteroid resolvents]. Terapevt. arkhiv. 2015;(4):58–61.