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
Abstract.
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.
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